2. Right pneumothorax

Air in the pleural space, a pneumothorax, is a well-known complication of thoracentesis. It usually occurs because of air entering the pleural space during the needle insertion. However, this pneumothorax was on the contralateral side of the thoracentesis. There is both hilar retraction and left upper lobe changes on the post-thoracentesis radiograph, but these were present on the baseline radiograph shown in Figure 1. Lung sliding is when respiratory movement can be observed at the lung surface during ultrasound (1). If present, lung sliding rules out a pneumothorax. Some studies report that the bedside ultrasound is better than CXR for ruling out pneumothorax (2).

In our patient, a post procedure ultrasound showed clear unambiguous lung sliding on the left side. The fluid cytology was negative for malignancy.       There was disagreement between the clinicians and the radiologists about the presence of a right-sided pneumothorax.  However, the patient was asymptomatic and wanted to go home to his home east of Phoenix at an elevation of about 5000 feet.

Which of the following are true?

  1. A thoracic CT scan could convincingly rule out a pneumothorax
  2. Tube thoracostomy needs to be performed in all cases of pneumothorax
  3. A pneumothorax may expand at high altitude
  4. A + C
  5. All of the above

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