PMC6611010_01
Chest X-ray showing extensive right side pneumothorax (yellow arrow) complicated by complete right lung collapse (red arrows).
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An emergent chest X-ray (CXR) showed massive right-sided tension pneumothorax with collapsed right lung (Figure 1).
Noncontrast chest CT scan showing resolving right side pneumothorax (green arrow), mild right subcutaneous emphysema (blue arrows), right-side chest tube (placed for tension pneumothorax; Red arrow). No pulmonary nodules were seen.
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A confirmatory computed tomography (CT) of the chest showed well-positioned chest tube, right pneumothorax, and no pulmonary nodules (Figure 2). On day 2, the chest tube was removed due to slippage into the subcutaneous layer and the formation of subcutaneous emphysema (Figure 2), and pneumothorax was confirmed to be mostly resolved.
Image was taken intra-operatively showing the broncho-pleural fistula (blue arrow).
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A standard posterolateral thoracotomy and pleuritic exploration showed the presence of BPF at the apical segment of the right lower lobe (Figure 3).
Hematoxylin and eosin section of right lower lobe wedge biopsy showing (A) fibrosing pleuritis and subpleural septal fibrosis (black arrows) with (B) acute and chronic histiocytic inflammation (yellow arrows). No pulmonary nodules were seen.
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The pathological examination of right lower lobe wedge biopsy revealed fibrosing pleuritis with acute and chronic histiocytic inflammation and subpleural septal fibrosis (Figure 4).