PMC8510795_01
(a) Echocardiography in the acute phase. The first echocardiography showing modified 4 ch view of end-diastolic and end-systolic left ventricular volume. Basal hypercontraction and apical ballooning is evident, interpreted as acute heart failure/takotsubo cardiomyopathy. (b) Echocardiography after remission of tension pneumothorax and subcutaneous emphysema. Follow-up echocardiography showing 4 ch view of end-diastolic and end-systolic left ventricular volume 1 month later. Left ventricular ejection fraction (LVEF) has normalized.
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fig1
An echocardiography (Figure 1(a)) performed in the ED showed decreased left ventricular ejection fraction (LVEF) with basal hypercontraction and apical akinesia, which was interpreted as acute heart failure. The follow-up echocardiography showed complete recovery of left ventricular function (Figure 1(b)).
(a) Chest X-ray showing tension pneumothorax of the left lung. The first chest X-ray showed a large left-sided rim pneumothorax, extending along the entire lateral border of the lung, from the base to the apex, and with a maximal width of 6 cm at the base of the left lung. (b) Chest X-ray showing subcutaneous emphysema. A postintervention chest X-ray showed an intercostal drain placed at about the 8th intercostal space on the left side. A near complete regression of the pneumothorax is seen, with the lung parenchyma again extending to the borders the left hemithorax and a smaller residual rim apicolaterally measuring 12 mm. In the soft tissues at the puncture point, multiple diffuse hypodense areas are seen, resembling subcutaneous emphysema.
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The patient's blood pressure remained low but unchanged, and therefore, an acute chest X-ray was performed (Figure 2(a)), which showed a large left-sided rim pneumothorax, extending along the entire lateral border of the lung from the base to the apex. The patient had tachycardia and dyspnea and was unable to open her eyes due to the massive subcutaneous emphysema (Figure 2(b)).