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Case of the Month 02/09
Q: This healthy 31-year-old male presented to the ED complaining of shortness of breath after an assault during which he was stabbed in the back. The first x-ray was taken at 3 pm.
What is wrong with this picture?
What is wrong with this picture?
A:
There is a right-sided pneumothorax.
Q: The second x-ray was taken at 3:45 pm after chest tube placement.
What is wrong with this picture?
What is wrong with this picture?
A:
The chest tube is not placed correctly (see the last hole in the subcutaneous tissue.)
The third x-ray (below) was taken at 6:30 pm after the first chest tube was removed and another chest tube was placed. (see below)
A chest CT was done as part of the trauma work up at 11 pm.
Q: What is wrong with these pictures (from the CT?)
A:
In spite of the normal appearance of the post-chest tube placement CXR, the chest tube is coursing through the subcutaneous tissue outside of the chest wall cavity (see circles). It is important when placing a chest tube to remember to sweep the inside of the chest cavity with the finger after the opening is made (both to lyse any adhesions and also to ascertain position inside the chest cavity).
After this CT, the patient had a third chest tube placed which was in proper location. This patient had the (properly placed) chest tube removed on hospital day 2 and was discharged on day 3 without complications.
