Brandon Fainstad, MD
Objectives
- Identify characteristic findings of a pneumothorax and response to decompression by a chest tube.
Teaching Instructions
Plan to spend 5-10 minutes familiarizing yourself with the animations of the power point and the key findings of this chest X-ray.
Present the image either by expanding the window (bottom right) in a browser or downloading the PowerPoint file. Have the image pulled up in presenter mode before learners look at the screen to avoid revealing the diagnosis. Advance through the animations to prompt learners with key questions and reveal the findings, diagnosis and teaching points. Read the following beforehand in preparation:Â
Official read:
Diffuse cystic disease throughout both
lung fields. Right pneumothorax without significant mediastinal shifting..
Additional teaching:
A pneumothorax is identified by two features: 1. Separations of the pleura and 2. the absence of bronchovascular markings. After identifying a pneumothorax it is important to look for features that could explain how it developed and evaluate for mediastinal shift to assess for the possibility of a tension pneumothorax. In this case there is diffuse cystic changes that likely led to a spontaneous pneumothorax. In other cases there may be evidence of trauma, instrumentation/procedures, bullous disease or Marfan’s syndrome.
Presentation Board
Take Home Point
- Pneumothorax is identified by a linear margin of the visceral pleura and the absence of bronchovascular markings in the periphery.
- Evaluate for tension pneumothorax by assessing for mediastinal shift away from the pneumothorax.
References
McLoud, Boiselle, & Boiselle, Phillip M. (2010). Thoracic radiology : The requisites (2nd ed., Requisites in radiology). Philadelphia: Mosby/Elsevier.
