A young man with a history of right sided pneumothorax, apical bullectomy and VATS pleurodesis presents with right sided pleuritic chest pain. You are asked to exclude recurrent pneumothorax.
Describe and interpret these scans
Image 1: Right 2nd interspace, MCL, longitudinal view:
There is no lung sliding however comet tail artefact is seen and the two pleural surfaces are directly opposed.
Pleurodesis. Cause for chest pain not determined by this scan.
Loss of lung sliding is one of the cardinal features of pneumothorax. In this case with the high frequency linear transducer both the parietal and visceral pleural surfaces are visible directly opposing one another.
In addition short path vertical reverberation artefacts (comet tails) produced at the visceral pleural surface are well demonstrated. This confirms that although there is no lung sliding, the pleural surfaces at this point are in direct contact.
This is consistent with previous pleurodesis. Examination of the hemithorax was otherwise unremarkable and chest x-ray too was within normal limits.