Single lung with bilateral pneumothorax
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IMAGING IN INTENSIVE CARE MEDICINE
Single lung with bilateral pneumothorax Li‑Ta Keng* and Lih‑Yu Chang © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
A 36-year-old man with a history of left upper lobectomy for empyema when he was four presented to the emergency department with subsequent intubation for acute respiratory failure. A post-intubation radiograph of the chest showed an opacity in the left lower lung zone, mediastinal shift to the left side with hyperinflated right hemithorax, and the presence of pleural lines with lack of lung markings in the periphery bilaterally (Fig. 1a). A computed tomography of the chest showed a large area of herniated right lung into the left thoracic cavity across
the anterior mediastinum. There was prompt resolution of the bilateral pneumothorax after an emergency right tube thoracostomy (Fig. 1b). The left main bronchus was occluded, with severely atelectatic or hypoplastic left lung (Fig. 2). The radiographically residual left lung was actually the anatomically herniated right lung and the bilateral intrapleural air accumulation developed as a result of pneumothorax of the hyperinflated right lung. Anterior lung herniation refers to the herniation of the lung and pleural sac across the anterior mediastinum
Fig. 1 a Radiograph of the chest showing an opacity in the left lower lung zone, mediastinal shift to the left side with hyperinflated right hemitho‑ rax, and the presence of pleural lines with lack of lung markings in the periphery bilaterally (arrows). b Computed tomography of the chest showing a large area of herniated right lung into left thoracic cavity across the anterior mediastinum with prompt resolution of the bilateral pneumothorax after emergent right tube thoracostomy
*Correspondence: [email protected] Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City 30059, Taiwan
with displacement of the anterior junction line on chest imaging. Compensatory hyperinflation and herniation of the lung can be seen in patients with congenital diseases such as scimitar syndrome or sequestration, severely atelectatic contralateral lung, or status post-pneumonectomy. This case illustrated an unusual but potential mechanism of bilateral pneumothorax: a hyperinflated and herniated single lung into the contralateral side of the thoracic cavity. In this case, one chest tube did resolve the bilateral pneumothorax. Authors’ contributions L-TK drafted the manuscript. L-YC prepared images and revised the manuscript. Funding None. Compliance with ethical standards Conflicts of interest The authors declare that they have no conflict of interest.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub‑ lished maps and institutional affiliations. Received: 15 January 2020 Accepted: 7 March 2020
Fig. 2 Computed tomography of the chest (a upper lung level; b middle lung level; c lower lung level) showing the occluded left main bronchus with severely
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