PMC4976133_01
(A) Chest X-ray PA view showing an opacity (approximately 3 x 3 cm) at the right hilar region with silhouette sign. Bilateral flattening of the diaphragms, a long narrow heart shadow, hyperlucency of the lungs with rapid tapering of vascular shadows are noted. (B) Chest X-ray PA view showing a large pneumothorax with a larger lung opacity than the previous X-ray. (C) Chest X-ray AP view (supine) showing chest drain in situ in the 7th right intercostal space pointing centrally and lying just above the right diaphragm.
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A chest X-ray confirmed a large Right pneumothorax. (Fig. 1B) An urgent bedside tube thoracostomy with a 32 F Malecot catheter was done and connected to an underwater seal.
(A) Extensive subcutaneous emphysema resulting in closure of palpebral fissures. (B) Patient sitting upright on his bed 10 min after insertion of a high negative pressure subcutaneous suction drain. (C) Patient is able to open his eyes after drain insertion. (D) Patient on post drain insertion day 2.
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There was an immediate relief to the patient and the patient could open his eyes immediately (Fig. 2).
(A) Contrast enhanced CT thorax showing chest tube lying in the right oblique fissure, marked right pneumothorax, extensive bilateral subcutaneous emphysema, and a large heterogeneous density lesion with irregular margins in right lower lobe extending in right upper and middle lobe with size 100 x 93 x 107 mm which was predominantly necrotic with mild enhancement on post contrast scans. (B) Note the emphysematous bullae in bilateral lung fields.
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A repeat CECT thorax showed the chest tube to be located in the Right oblique fissure with marked right pneumothorax, extensive bilateral SE, presence of emphysematous bullae in bilateral lung fields, and a large heterogeneous density lesion with irregular margins in right lower lobe (Fig. 3).