Interactive Case Discussion #12

Kerby Chloe A. Go

CASE 12

• 50/M• Came in from another institution with severe

difficulty of breathing. He came in with a chest x-ray done outside and when your resident saw the film, the patient was immediately referred for surgical management.

• Repeat chest x-ray was performed afterwards exhibiting the following..

Chest tube Insertion

• inserted to drain blood, fluid, or air and to allow the lungs to fully expand

• Indication:– Pneumothorax– Tension pneumothorax– Hemothorax– empyema

Procedure

• Point of insertion: anterior axillary line• Aseptic technique and local anesthesia is

applied• The free end of the tube is usually attached to

an underwater seal below the level of the chest

Pneumothorax

• Collection of air or gas in the pleural cavity of the chest

• May occur spontaneously or with physical trauma, blunt injury/trauma, or as complication of medical therapy

• Presents as dyspnea in most cases

Tension pneumothorax

• If the penumothorax leads to oxygen shortage and low blood pressure, progressing to cardiac arrest

Pneumohydrothorax

• Air or gas with fluid in the pleural cavity

• Caused by:– Infectious

• TB– Neoplastic

• Mesothelioma– Anatomic, foreign body

or structural disorders• Perforated/ruptured

esophagus

• Common clinical surgical rule: pneumothorax greater than 25% requires chest tube drainage

• Air slowly resorbs from the pleural space at a rate of approximately 1.5% / day. This rate will increase with use of supplemental oxygen.

• www.chestx-ray.com/calculator/ptx.html - link for pneumothorax calculator