Presentation
Chronic left pleural effusion. Post thoracocentesis.
Patient Data
Left basal pneumothorax with air-fluid level and mensiscus indicating that this is actually a hydropneumothorax. Left chest wall subcutaneous emphysema. Left upper and lower lobe atelectasis. Right upper lobe granuloma.
Case Discussion
Most pneumothoraces post ultrasounded-guided thoracentesis (which are uncommon in themselves) result from unavoidable stress-related parenchymal-pleural fistulas that result from trapped (unexpandable) lung rather than being procedure related (e.g. direct lung puncture, poor technique).
Radiographic signs of trapped lung include:
- visceral pleural peel (thickening)
- basilar pneumothorax
- ipsilateral volume loss
- lobar atelectasis
Often treatment of these pneumothoraces with chest tubes is unsuccessful and most will slowly resolve in their own time.