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Image challenge
An unusual mediastinal shift
  1. Cheng-Wei Tseng1,
  2. Tzu-Yao Hung1,2
  1. 1 Emergency, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
  2. 2 CrazyatLAB (Critical Airway Training Course), National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
  1. Correspondence to Dr Tzu-Yao Hung, Emergency, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; bryansolitude{at}gmail.com

https://doi.org/10.1136/emermed-2023-213745

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    Clinical introduction

    A woman aged 61 years with a history of diabetes mellitus presented to the ED with acute dyspnoea and altered consciousness for 1 day. Her RR was 36 breaths/min and BP was 81/60 mm Hg. Examination revealed decreased breath sounds in the left lung. A CXR was performed (figure 1).

    Figure 1

    Patient’s initial CXR.

    Question

    Based on the imaging, which of the following is the most likely diagnosis?

    1. Large pleural effusion

    2. Tension pneumothorax

    3. Tension pyopneumothorax

    4. Gastrothorax

    Answer: C

    Answer and discussion

    The CXR shows a substantial air-fluid accumulation in the left hemithorax, causing a mediastinal …

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    Footnotes

    • Handling editor Sarah Edwards

    • Contributors C-WT: patient management and care, collection of clinical data and imaging, initial manuscript drafting, final approval of the version to be published. T-YH: interpretation of clinical data and imaging findings, critical revision and editing of the manuscript, supervision and mentorship, final approval of the version to be published. Both authors have read and approved the final manuscript. C-WT is a first author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.