A Posterior Pneumothorax

Abstract

1Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine; 2Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan Correspondence: Dr Julian S Tam, Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, 5th Floor Ellis Hall, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8. Telephone 306-966-8274, fax 306-966-8694, e-mail contact@juliantam.com A 60-year-old woman with interstitial lung disease was reviewed in clinic three weeks after undergoing a right lower lobe lung biopsy via video-assisted thoracoscopic surgery. Chest imaging studies had revealed bilateral reticular markings with peripheral and lower lung zone predominance. The pathology documented constrictive bronchiolitis and a usual interstitial pneumonia (UIP)-type fibrosing interstitial pneumonia. The patient described modest worsening of dyspnea on exertion and discomfort in her right-lower chest following her surgery; she attributed this to expected sequelae of surgery. The initial chest radiograph revealed lung markings extending to the chest wall, but increased radiolucency in the right base compared with previous. Shift of the heart to the left, depression of the right hemidiaphragm and an apparent prominent right hilum were also seen (Figure 1). On bedside right-sided chest ultrasonographic examination, positive sliding pleural and seashore signs were elicited anteriorly; posterior examination was significant for negative sliding pleural and positive barcode signs (1) (Figures 2 and 3, Videos 1 and 2 [click on the camera icons in the video legends on this page]). A computed tomography scan of the chest confirmed the diagnosis of a large, posterior right-sided pneumothorax (Figure 4). The patient was admitted to hospital and a chest tube was inserted. Her hospital admission was prolonged due to a persistent air leak. Following drainage of the pneumothorax, subsequent chest radiographs showed re-expansion of the right lung (Figure 5). imAges in respirAtory medicine