PMC6402233_01
Thorax CT without contrast demonstrates subcutaneous emphysema, right lobe lung collapse, and absence of pneumothorax on the left side. Red arrows indicate chest tubes. Blue arrows indicate pneumothorax. Yellow arrows indicate bullae.
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The scan revealed giant bullous emphysema on the superior lobes bilaterally, right pneumothorax with a collapsed lung, along with multiple rib fractures, and lung emphysema (Fig. 1, Fig. 2).
Thorax CT without contrast performed at admission on the left side, and one day after bullectomy on the right side. It demonstrates a significant improvement in pulmonary expansion after decortication of right lobe; the collapsed left side, however, was not demonstrated at time of admission to the trauma center, in a left image.
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After surgery, the right side fistula was resolved (Fig. 3).
Thorax CT without contrast, bullectomy post-operative. The blue arrow indicates empyema and incarceration.
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Four days after surgery, the patient developed a right-sided empyema, right lung incarceration, and blood clots in the chest tube (Fig. 4).
Thorax CT without contrast demonstrating a bilateral pulmonary consolidation despite pulmonary expansion.
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In order to resolve these issues, videothoracoscopy and decortication of the right lung were performed, which resulted in the resolution of these problems (Fig. 5) and improvement in ventilatory parameters with conservative treatment for the left lung.