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Case Reports
. 2014 May 16:2014:bcr2013203435.
doi: 10.1136/bcr-2013-203435.

A mistaken case of tension pneumothorax

Michael Joseph Newman  1
Affiliations
Case Reports

A mistaken case of tension pneumothorax

Michael Joseph Newman. BMJ Case Rep. .

Abstract

The patient was an otherwise usually fit and well 25-year-old man who presented to A&E department in extremis. The initial working diagnosis was a tension pneumothorax, and he was subsequently treated with needle thoracocentesis causing a release of air. A chest radiograph was taken, after which a chest drain was inserted. Bilious fluid was drained from the chest drain. The patient was taken for an emergency CT, which demonstrated a Bochdalek diaphragmatic hernia, with the spleen and bowel found to be causing a near total left lung collapse. He was taken to the theatre to return the bowel to the correct anatomical position, in addition to undergoing a sleeve gastrectomy, and diaphragmatic defect repair. The patient has had a complex and protracted recovery in the intensive therapy unit (ITU) with complications including wound dehiscence, gastrectomy leak requiring additional surgical repair, fluid overload and bilateral pleural empyema.

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Figures

Figure 1
Figure 1
Radiograph on admission.
Figure 2
Figure 2
Initial CT scan (coronal view).
Figure 3
Figure 3
Initial CT scan (axial view).
Figure 4
Figure 4
Postoperative chest radiograph.
See this image and copyright information in PMC

References

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