Chest pain from chest drain

A 39-year-old man presented with severe COVID-19 pneumonitis requiring hospital admission. He represented three days following discharge with sudden onset breathlessness and chest pain. Initial imaging suggested the presence of a left pneumothorax. Following further clinical decline a plan was made to insert a CT guided chest drain. However, imaging in the prone position for the procedure unexpectedly revealed a large left lower lobe pneumatocele with only a very small pneumothorax. Events and appearances suggest that this is a rare case of delayed COVID-19 pneumonitis-related pneumatocele formation. We will discuss the clinical significance of this entity.

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Suspecting a fatal condition on a plain chest radiograph; Boerhaave syndrome

Scottish Medical Journal ◽

10.1177/0036933020961181 ◽

2020 ◽

pp. 003693302096118

Author(s):

Muhammad Adeel Rizwan Hashmi ◽

Moustafa El-Badawy ◽

Adnan Agha

Keyword(s):

Chest Pain ◽

Chest Radiograph ◽

Medical Condition ◽

Organ Support ◽

Chest Drain ◽

Diagnostic Challenge ◽

Plain Chest Radiograph ◽

Pulmonary Angiogram ◽

History Of ◽

Boerhaave Syndrome

Spontaneous oesophagus rupture, also known as Boerhaave syndrome, is a rare but near-fatal medical condition and despite recent medical advancements, it remains a diagnostic challenge for front-door clinicians. The authors describe a similar presentation in an elderly gentleman who presented to the emergency department with sudden chest pain post vomiting. His initial chest radiograph showed bilateral dense consolidations and pleural effusions, and was treated as sepsis secondary to bilateral pneumonia. He underwent computed tomography pulmonary angiogram to rule out pulmonary embolism because of his chest pain with elevated D-dimer which confirmed the diagnosis of oesophagus rupture. His care was transferred to Surgical and Intensive care colleagues with plans for radiological chest drain insertion to limit contamination of mediastinum, however the patient became hypoxic and hypotensive and despite maximal organ support passed away within 6 hours of admission. Retrospect review of chest radiograph revealed Peri-oesophageal air tracking, a sign of Boerhaave syndrome. The aim of this case is to emphasise the importance of raising the suspicion of Boerhaave syndrome in patients with sudden chest pain, unexplained pleural effusion or pneumothorax with a history of recent vomiting as early diagnosis holds the key to prompt lifesaving management.

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Simultaneous bilateral spontaneous pneumothorax

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh170504125k ◽

2018 ◽

Vol 146 (3-4) ◽

pp. 203-206

Author(s):

Vanja Kostovski ◽

Aleksandar Ristanovic ◽

Nebojsa Maric ◽

Natasa Vesovic ◽

Ljubinko Djenic

Keyword(s):

Chest Pain ◽

Chest Radiograph ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Diagnostic Algorithm ◽

Chest Drain ◽

Initial Examination ◽

Breath Sounds ◽

Pleural Abrasion ◽

Life Threatening

Introduction. Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlights the potential difficulties in diagnosis and management of patients with SBSP. Case outline. A 23-year-old female was urgently assessed because of a progressive dyspnoea of 2-day's duration with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During initial examination, there was the evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea and agitation. She was found to have type II respiratory failure with the following biochemical parameters: pH=7.34, PaCO2=6.3 kPa and PaO2=7.9 kPa. The chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, she subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies and pleural abrasion. Her chest drains were removed 3 days after surgery and a chest radiograph post-treatment demonstrated resolution of the pneumothoraces. She was discharged home without complications. Conclusion. Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.

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