PMC4614334_01
Initial chest x-ray performed at the primary health clinic.
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Chest x-ray (CXR) was performed at this point which revealed a large pneumothorax with minimal pleural effusion (Figure 1). CXR was repeated post-needle decompression (Figure 2), which showed a smaller pneumothorax and an increase in the size of the effusion compared to the first CXR from the PHC (Figure 1). The low pH pleural fluid and presence of effusion before needle decompression on initial CXR (Figure 1) indicated a presence of initial empyema.
Post-needle decompression.
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CXR was repeated post-needle decompression (Figure 2), which showed a smaller pneumothorax and an increase in the size of the effusion compared to the first CXR from the PHC (Figure 1).
Post-chest tube insertion.
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At this point, a chest tube was inserted which immediately drained 1.4 liters of blood, suggesting an iatrogenic hemothorax (Figure 3).
Chest CT scan.
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CT scan was requested post-chest tube insertion, which revealed consolidation in the left lower lung lobe, atelectasis changes in the posterior segment of the left upper lung lobe, a trace of pleural effusion and an air-bronchogram in the left lower lobe (Figure 4).