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41. Radiology Case 8
Indication for Examination: 20-year-old male presents with right-sided chest pain and dyspnea. On exam, there are diminished breath sounds and hyperresonance on the right.
Radiographic Findings
Lack of extension of the right lung to the edge of the chest cavity
Diagnosis
Large right pneumothorax
Learning Points
Priming questions
What are the best patient positions to evaluate for pneumothorax on X-ray?
What are some common mimics of pneumothorax?
What are signs of tension pneumothorax?
Introduction
Pneumothorax is an abnormal collection of air within the pleural space, which can cause mass effect on the adjacent lung.
Tension pneumothorax occurs when air accumulates and causes pressure on the mediastinal structures eventually causing decreased venous return and cardiopulmonary collapse [1].
Pathophysiology/Mechanism
There are many causes of pneumothorax.
Primary spontaneous pneumothorax is seen in patients with no underlying lung disease, most commonly thin young men.
Blunt trauma, approximately 30–40% of patients with blunt chest trauma have an associated pneumothorax.
Iatrogenic
Barotrauma from ventilation
Post bronchoscopy
Post thoracentesis or lung biopsy
Following central line placement.
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