Pneumothorax Case Studies

Exams that can be done (all radiology and ancillary) A chest x-ray is the primary way to diagnose a pneumothorax. Generally two chest x-rays will be taken, one on inspiration and one on expiration. This allows to better visualize the collapsed lung. An additional CT scan may be required. Ultrasound may also be used.

Etiology Imagine waking up in the morning to the discomfort of not being able to take a proper ventilation. Horrible, right? This is what people who have pleural effusions feel. I chose to do my paper on pleural effusions. Pleural effusions are a collection of fluid in the pleural space, the cavity surrounding the lungs. Typically, there is 10 mL of fluid in this space to lubricate the pleura, however when disrupted by diseases such as pneumonia, pulmonary embolisms, congestive heart failure, or cancer, fluid begins to third space and collect in abnormal amounts. The biggest challenge then becomes dyspnea and tachypnea. This is because the extra fluid decreases pressure making it difficult for the lung to fully expand. Pleural effusions

Pt received AP diameter X-ray to confirm tube placement and to see if there were any kind of infiltrates because of possible aspiration and to eliminate possible pneumothorax and pleural effusion. Findings included mild patchy infiltrates in the right upper to middle lobes. The left lower lobe also has some similar findings but less concerning. This may either be due to lung infection or pulmonary

EBUS-TBNA Utility versus Mediastinoscopy Introduction The primary rule of any treatment regimen is to first do no harm which is the first paradigm learned in any healthcare training program. This necessarily covers a large grouping of consequences among which are physical, emotional and financial harm. It is imperative that treatments continuously

82 developed an index defined as GAP (gender, age, physiology), in order to predict mortality in IPF. US and Italian patients included in this study were divided in three groups: 228 patients, 44.3% of which with biopsy proven IPF, were included in the derivation cohort and 555, 54.7% of which with biopsy, in two validation cohorts of 330 and 325 patients. Mean follow-up was 1.7 and 2.4 in the derivation and the validation cohorts, respectively. The primary endpoint of the study was time to death or lung transplantation. Overall mortality was 49% in the derivation cohort and 62% in the validation cohorts. A competing-risk regression model was used to screen potential predictors of mortality in the derivation cohort including age, sex, body mass index (BMI), smoking status, supplemental oxygen use, FVC, FEV1, TLC and DLCO. Age, sex, FVC% predicted and DLCO% predicted were identified as independent predictors and were used to develop the GAP individual risk calculator towards mortality and staging system. Three stages (stages I, II, and III) were identified based on the GAP index with 1-year mortality of 6%,16%, and 39%,

A thoracoscopy (inserting a tube with a camera into the chest) can be used to acquire biopsy material.For sure it allows the introduction of substances such as talc to obliterate the pleural space (a procedure called pleurodesis), preventing more fluid from accumulating and pressing on the lung.

Traumatic pneumothorax is either iatrogenic (i.e., caused by transthoracic or transbronchial biopsies, central venous catheterizations, pleural biopsy, thoracentesis) or non-iatrogenic following blunt or penetrating chest injuries (Oveland 2013).

We review air embolism in the context of interventional radiology, although air embolism can also occur with barotrauma, lung biopsies and during surgical procedures, most notably neurosurgery and cardiothoracic surgery. In the former, patients may be operated on in the upright position,

Knowlton has had insidious progression of dyspnea on exertion over the course of one to two years. His pulmonary function tests do demonstrate a restrictive ventilatory defect with significant decrement to his DLCO. He has a very significant smoking history. However by imaging, the is no evidence of any emphysematous disease. Additionally, there is no evidence of obstruction on his pulmonary function tests. The differential diagnosis for restrictive ventilatory defects are quite broad to include intrinsic lung disease versus neuromuscular weakness verus non-muscular diseases of the upper thorax to include kyphoscoliosis. It should be noted that Mr. Knowlton does have a fair amount of stooped posture and kyphosis on examination, however this should not contribute to the level of decreased DLCO noted on his pulmonary function tests. At this time, it would be reasonable to interrogate the lung parenchyma with high resolution CT scanning given the pulmonary function tests

Follow up of patients after US guided pleural needle biopsy and medical thoracoscopy (Table 4)

Lung ultrasonography is a fast, non-expensive, widely available bed-side diagnostic tool which is useful for quick and early diagnosis of respiratory diseases. The aim of the work was to evaluate the role of the chest ultrasound in the assessment of intensive care unit

Consequently, EBUS-TBNA was recommended as a vital tool for lung cancer patients with preoperative assessment by U.S. National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) in 2007. Endobronchial ultrasound-guided transbronchial needle aspiration has been widely applied in a variety of the diagnosis of breast disease in nations, especially developed nation. However, this procedure was used in China at 2008 and the procedure is still in the development stage in China at present. The main operation indications of EBUS-TBNA are that [11]: (i) The stage of lymph node (LN). (ii) The diagnosis of lung cancer. (iii) The diagnosis of unexplained hilar and/or mediastinal enlarged lymph node (LN). (iv) The diagnosis of mediastinal tumor. (v) The External pressure lesions of trachea and bronchus. (vi) The diagnosis of submucosal lesions. (vii) Tracking small cell

The hospital were the samples were collected, was following NICE guidelines with regards the use of mediastinoscopy.

The authors begin defending their stance by providing several reasons for the recent surge of CT procedures: rapid technological advances, convenience to the patient and cost effectiveness (David & Hall, 2007). The calculated dose a patient receives from a CT procedure is only an estimated exposure dose. To date, a patient’s

* Diminished breath sounds Rationale: This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.