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Answers to the January 2005 Radiology Quiz
This patient is a 16 year old male who presents to the emergency department status post stab wound to the right chest. The following radiograph was taken.
Questions:
1. Describe what you see? Portable CXR which shows collapse of the right lung with mediastinial shift to the left.
2. What signs and symptoms would this patient present with?
- · Chest pain (90%)
- · Dyspnea (80%)
- · Anxiety
- · Fatigue
3. What would you find on physical exam?
- · Respiratory distress and/or arrest
- · Cyanosis
- · Unilaterally decreased or absent lung sounds
- · Lung sounds transmitted from the nonaffected hemithorax are minimal with auscultation at the midaxillary line
- · Tachypnea
- · Hyperresonance of the chest wall on percussion
- · Increasing resistance to providing adequate ventilation assistance
- · Tachycardia
- · Tracheal deviation (relatively late finding due to midline shift with a tension pneumothorax)
- · Jugular venous distension (with a tension pneumothorax)
- · Hypotension (key sign of a tension pneumothorax)
- · Pulsus paradoxus
- · Mental status changes, including decreased alertness and/or consciousness
4. How would you manage this patient?
- · Immediately perform needle thoracostomy or chest tube placement. Once a needle thoracostomy has been performed, chest tube insertion must follow.
- · If a hemothorax is associated with the pneumothorax, additional chest tubes may be needed to assist drainage of blood and clots. If the hemopneumothorax requires insertion of a second chest tube, the second tube should be directed inferiorly and should be posterior to the diaphragm.
Trivia: Who was the Beatles' drummer before Ringo Starr?
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