Question

A 42-year-old Caucasian female, Ms. R., presents to the emergency room 4 days after being knocked down by a wave at the beach. When she was knocked down, she did not lose consciousness. However, she did develop some back pain as well as some dyspnea on exertion. These symptoms did not worsen over the past 4 days nor did they improve. For this reason, she presented to the emergency room. Upon further discussion with the patient, we learn that Ms. R. had a pneumothorax in 2008 when she had a very severe pneumonia. Her past medical history consists of hypertension, allergy-related asthma, and recurrent rightsided pneumothoraces. In terms of her medication, she takes hyzaar/hydrochlorothiazide. She is allergic to ACE inhibitors that cause facial numbness. Her social history consists of no alcohol or illicit drug use. She did smoke a pack of cigarettes a day from the age of 17 to age of 32; therefore, she smoked for 15 years. She has the following vital signs: temperature of 99.4°F, heart rate of 110, respiratory rate of 30 breaths/min, blood pressure of 164/84 mm Hg, height of 168 cm, weight of 88.7 kg, and pulse oximetry of 88% on room air. Her physical examination findings are benign with the exception of her respiratory examination. She has some increased work of breathing. Her breath sounds are clear upon auscultation on the left lung fields. On the right lung fields, her breath sounds are clear in the right lower and middle lobes and somewhat diminished in her right upper lobe. She also complains of pleuritic pain with deep inspiration. A posteroanterior (PA) and lateral chest x-ray was performed that revealed no pulmonary infiltrates but did show slight white-out in the right upper lung field on the PA view. In the lateral view, the x-ray film showed an air level in the upper lung field.

3. Is there a role for surgical treatment? If so, what are the options?

Answer 1

Past Medical history:

Ms.R is a known case of pneumonia, hypertension, allergy related asthma, recurrent right sided pneumothoraces

Present Complaint:

Back pain

Pleuritic pain on deep inspiration

Dyspnoea Spo2 -88% in Room air

Hypertensive 164/84 mmHg

Tachycardia - 110 beats/ minute

Mild Fever - 99.4° F

Tachypnea 30 breath / minute

On auscultation breath sounds are diminished on right lower lobe.

Chest x-ray reveals white- outon right lung field

These all assessment helps us find out she has Pnemothorax.

It is Secondary spontaneous Pnemothorax because she already has underlying cause like smoking,lung diseases

" It is the collection of air in the pleural space"

Surgical treatment may be necessary

The options are

Conservative treatment is not the right choice

Chest Tube ( Intercoastal drain, chest drain, thoracic catheter,tube thoracostomy) is insertion of a Tube into the pleural cavity to remove the air

Plerodesis has the chance to reduce the recurrence

Video assisted thoracoscopy surgery reduce the chance of recurrent Pnemothorax.

Hence doing this procedure will help her for better progress and improvement to achieve her quality of life