Repeat CXR to confirm endotracheal tube placement showed worsening fluid accumulation in the affected lung ( Figure 3).įIGURE 3. The patient demonstrated persistent hypoxia and worsening tachypnea subsequently requiring intubation for hypoxic respiratory failure. Second CXR at 20:01 confirming placement of a small caliber thoracostomy tube and new consolidation in the left lower lung. Despite the confirmation of the pig-tail catheter on CXR ( Figure 2), a large-bore chest tube was placed instead without any clinical improvement.įIGURE 2. After placement, the patient continued to complain of shortness of breath, developing new hypoxemia. (white circular markings)Ī small-bore chest tube (pig-tail catheter) was placed. Initial CXR at 18:32 showing a large pneumothorax in the left upper lobe along with a fracture of the lateral aspect of the sixth rib. On arrival, a chest x-ray (CXR) was obtained ( Figure 1), revealing a left pneumothorax and associated lateral 6th rib fracture.įIGURE 1. The treatment of choice for a pneumothorax is a chest tube, and when the small pig-tail catheter doesn’t do the job, the answer is to replace it with a larger bore – right? Not so fast.Ī 39-year-old male presented to the emergency department with the chief complaint of difficulty breathing after being punched in the chest 3 days prior.
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