Radiology Review

When the Diagnosis Hurts

Clinician Reviews. 2017 March;27(3):19,39
Author(s):
Nandan R. Hichkad, PA-C, MMSc
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When the Diagnosis Hurts image

A 60-year-old man presents to the emergency department for evaluation of chest pain that began a few hours ago. He denies injury and has no associated nausea or shortness of breath. Earlier today, he underwent biopsy of a recently discovered mass in his right lung. Otherwise, his medical history is only significant for hypertension. He is a former pack-a-day smoker but quit three months ago.

On physical exam, you note an uncomfortable male in no obvious distress. He is afebrile, with normal vital signs. His O2 saturation is 96% on room air. Breath sounds appear to be clear bilaterally, although the patient expresses some discomfort with inhalation. Heart sounds are normal as well.

While the nurse and tech place an IV, a portable chest radiograph is obtained. What is your impression?


 

When the Diagnosis Hurts image

ANSWER

The radiograph shows an oval hyperdensity within the right mid lung, presumably the known lung mass. Of note, however, is an approximate 50% pneumothorax of the right lung. It is creating mild tension, indicated by the slightly displaced trachea. There is also evidence of subcutaneous air in the right lateral chest.

These findings likely result from a complication of the aforementioned biopsy. The patient underwent chest tube placement and was admitted for further treatment.

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