PMC9279614_01
Chest X-ray. (A) Left pneumothorax volume of approximately 30%. (B) Left pneumothorax with massive pleural effusion.
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F1
Two chest X-rays 3 h apart showed a pneumothorax volume of approximately 30% and slight dulling of the left costophrenic angle, without tendencies to worsen (Figure 1A). Bedside chest X-ray suggested left pneumothorax with massive pleural effusion (Figure 1B), and hemoglobin level was 105 g/L.
Contrast-enhanced chest computed tomography. (A) The lung window shows left hydropneumothorax; dorsal side of left lower lobe shows consolidation, which presents as atelectasis after compression. (B) The mediastinal window shows left hydropneumothorax; consolidation of the dorsal side of the left lower lobe is enhanced, which presents as atelectasis after compression; high-density lesion in the left dorsal pleural cavity has no enhancement, which is a blood clot; no blood vessels with abnormal morphology and density or contrast agent leaking into the thoracic cavity are found.
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F2
No large blood vessels with abnormal morphology and density or contrast agent leaking into thoracic cavity were found (Figures 2A,B).
Intraoperative exploration. (A) The abnormal branch of the left subclavian artery is ruptured, with a diameter of 2 mm. The proximal end is spasmodic, and the distal end forms thrombus, which is bleeding slowly. (B) The abnormal lung tissue in the apical segment of the upper lobe of the left lung, measuring 1 x 1 x 1 cm. The ruptured blood vessel supplying the abnormal lung tissue can be seen, with a diameter of 2 mm.
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F3
The proximal end was spasmodic, and the distal end formed a thrombus, which was bleeding slowly (Figure 3A). A ruptured blood vessel supplying the abnormal lung tissue could be seen, with a diameter of 2 mm (Figures 3B, 4A).
Pathological specimen and microscopic findings. (A) The abnormal supply vessel in the upper lobe apical segment of the left lung is ruptured, with a diameter of 2 mm. The surrounding lung tissue erodes and appears red. (B) There are many lymphocytic infiltration in the pulmonary interstitium along with mild hyperplasia of the pleural fibrous tissue. Numerous foam cells, cholesterol crystals, and multinucleated giant cell reactions are seen in the alveoli near the pleura.
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F4
A ruptured blood vessel supplying the abnormal lung tissue could be seen, with a diameter of 2 mm (Figures 3B, 4A). Numerous foam cells, cholesterol crystals, and multinucleated giant cell reactions were seen in the alveoli near the pleura (Figure 4B).