IMAGES IN EMERGENCY MEDICINE
Secondary spontaneous pneumothorax: indication for intercostal chest drain insertion?
Correspondence to:
Dr D K C Lee, Department of Respiratory Medicine, Southend University Hospital, Westcliff-on-Sea SS0 0RY, Essex, UK; dkclee@doctors.org.uk
Accepted 12 September 2007
| The first 150 words of the full text of this article appear below. |
A patient with chronic obstructive pulmonary disease presented with a history of sudden onset breathlessness and the chest radiograph shown in fig 1. Current guidelines advocate insertion of an intercostal chest drain for the treatment of significant primary pneumothoraces following failure of re-expansion after simple aspiration, with a recommendation of intercostal chest drainage for all cases of significant secondary pneumothoraces.
Figure 1 Chest radiograph.
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However, in this instance a chest drain could not be inserted to treat the secondary spontaneous pneumothorax as doing so would have led to lung injury. Closer inspection of the chest radiograph in fig 1 showed a large emphysematous bulla with a small apical pneumothorax of the left lung. The patient was treated conservatively with complete resolution of the secondary pneumothorax as spontaneous pneumothoraces are known to re-expand by about 2% daily.
Competing interests: None declared.
Details have been removed from this case description to ensure anonymity.
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