Pop Lung

Abstract

To the Editor: We recently saw a 24-year-old welder with acute onset of left pleuritic chest pain. The chest film showed a large pneumothorax, and a chest tube was placed low in the left posterior hemithorax. Re-expansion was immediate and symptoms abated concomitantly, but air leak persisted. Three days later the patient, still hospitalized, was seen on an emergency basis because of a new severe left chest and shoulder pain. On examination, the patient was in obvious distress from this pain. Initially, we thought that his lung had probably recollapsed, but physical examination revealed symmetric breath sounds. A chest film was obtained immediately. No recurrent pneumothorax was seen, but a generous gastric air bubble was present. On the patient’s bedside stand were noted three 64 ounce containers of a popular sweetened carbonated beverage, one of which had been emptied just prior to the onset of the pain. We surmised that the carbonated beverage resulted in gastric distention with upward displacement of the diaphragm and encroachment on the chest tube. The patient was advised to belch, and the immediate completion of this task resulted in dramatic relief of these symptoms. We suggest that this patient represents a new entity to add to the differential diagnosis of chest pain and have chosen to characterize his hospital course as Pop lung, type I and type II, respectively. We sincerely hope this air leak clears lest he should require surgery for stapling—in which case the radiologist might be tempted to read his “pop” film (with chest tube and staples) as Pop lung, type III!