This patient suffered right sided chest trauma with a rib fracture, tension pneumothorax and extensive surgical emphysema. An intercostal catheter was successfully placed and the patient improved.
On day 2 she suddenly deteriorated with increasing shortness of breath, hypoxia and mediastinal shift.
What do these scans demonstrate?
Ultrasound Clip 1
Right lung scan – the side of recent tension pneumothorax and subcutaneous emphysema.
Persistent superficial air obscures the deeper structures of the chest wall – intercostal muscles, ribs and pleural surfaces. It is not possible to tell whether the intercostal catheter is functioning or whether the pneumothorax has recurred.
Ultrasound Clip 2
Left lung scan. This demonstrates lung collapse with loss of aeration.
- The heart can be visualized through the collapsed lung.
- This is a case of resorption atelectasis. Mucous or blood plugging the left lower lobe bronchus has resulted in resorption of air within the lung, collapse, and mediastinal shift toward the collapsed side.
- Careful inspection of the bronchus which can be seen through the solid, airless lung revels an echogenic area moving in and out with each breath. This may represent the partially mobile obstruction itself, which cleared with aggressive chest physiotherapy.
What happened next?
A chest X-Ray is performed
Chest physiotherapy was ordered and the patient improved. A chest X-ray performed the next day is shown below.
- The chest x-ray shows the right sided pneumothorax has not recurred.
- There is left sided lung collapse, in this context likely due to mucous plugging and bronchial obstruction.
- Bronchoscopy was not feasible in this remote and small hospital.
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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPD | Ultrasound library | Top 100 | @thesonocave |