Our patient was a 63 year old AA male who was present in the ICU with sepsis requiring pressors. We looked at the standard sites for septic patients: Cardiac, IVC, and Lung. His cardiovascular exam was as we expected: he was known to have a decreased EF and due to his sepsis his IVC was small and collapsed completely on inspiration.
Next we moved on to his lungs. With the linear probe, we began to examine his anterior chest wall where we found bilateral pleural sliding. moving laterally on the right lung, however, we saw something we did not expect: a lack of pleural sliding with no evidence of effusion. How could this be? We saw in the anterior portion of the chest that there was no pneumothorax, yet in a less dependent area we see evidence of pneumothorax. We followed the pleural sliding that was found to lung points inferiorly and laterally and estimated the unaffected portion of the lung to be approximately 8 x 4 cm.
It was later determined that this phenomenon must have been caused by adhesions of the visceral to parietal pleura that prevented the pneumothorax from traveling to the most anterior portion of the chest, creating a loculated pneumothorax.
-Andrew Fellers, MS4
Mgonjwa huyo alikuwa na umri wa miaka 63 na alikuwa akipelekwa katika chumba cha wagonjwa mahututi (ICU) kwa sababu ya ugonjwa wa sepsis. Kwa mfano, kwa wagonjwa wa septic, kuna sehemu za kawaida za moyo, moyo wa ndani, na mapafu. Uchunguzi wake wa moyo na mishipa ya damu ulikuwa kama tulivyotarajia: alijulikana kuwa na EF iliyopungua na kwa sababu ya sepsis yake IVC yake ilikuwa ndogo na ilianguka kabisa kwa msukumo. Kisha tukaendelea na mapafu yake. Kwa kutumia chombo cha uchunguzi, tulianza kuchunguza ukuta wa mbele wa kifua chake ambapo tulipata mteremko wa pleural wa pande mbili. "Wakati wa uchunguzi wa mapafu ya kulia, tuliona kitu ambacho hatukutarajia: ""kutokuwa na mtiririko wa pleural na hakuna ushahidi wa kutokwa.""" Hilo linawezekanaje? Katika sehemu ya mbele ya kifua, hakuna pneumothorax, lakini katika sehemu isiyo na pneumothorax, kuna dalili za pneumothorax. Utaratibu wa kuunganisha pleura na mapafu ulifanywa kwa njia ya mviringo na kwa njia ya mviringo, na sehemu ya mapafu ambayo haikuathiriwa ilikuwa karibu 8 x 4 cm. Baadaye iligunduliwa kwamba hali hii ilisababishwa na kuunganishwa kwa pleura ya visceral na parietal ambayo ilizuia pneumothorax kusafiri hadi sehemu ya mbele ya kifua, na kuunda pneumothorax ya localized. Andrew Fellers, MS4