Case 44

27 y/o M presents to ED with chest pain that started a few hours PTA.  Patient notes associated left shoulder pain and shortness of breath but denies dizziness, lightheadedness, syncope. Patient is a current 1PPD smoker.

PE:

VITALS: T 97.4    HR 56     RR 20    BP 116 /73     Sa02 97% on RA
CONSTITUTIONAL: Mild distress due to pain
SKIN: Warm and dry, no acute rash.
HEAD: Normocephalic; atraumatic.
EYES: PERRL, EOM intact; conjunctiva and sclera clear.
ENT: No nasal discharge; airway clear.
NECK: Supple; non tender.
CARD: S1, S2 normal; no murmurs, gallops, or rubs. Regular rate and rhythm.
RESP: Diminished lung sounds on left, otherwise clear. No tracheal deviation or JVD.
ABD: Normal bowel sounds; soft; non-distended; non-tender
EXT: Normal ROM. No clubbing, cyanosis or edema.
NEURO: Alert, oriented, grossly unremarkable.

 

Questions:

  1. What probes are used in the above ultrasound clips?
  2. What are the names of the two signs seen on the above ultrasound clips?
  3. What is the diagnosis?
  4. What are your treatment options?

Answers:

  1. video A: linear probe
    video B: phased array probe

  2. Image 1 shows LUNG POINT: the transition--from sliding lung parenchyma to lung parenchyma which appears static because pneumothorax displaces it from the pleural wall
    Image 2 shows HEART POINT: where the heart fills with blood during diastole and displaces pneumothorax to touch the chest wall and become visible, then disappears during systole as the volume of blood decreases and the pneumothorax fills the space between the heart and the pleural wall obscuring the heart.

  3. Pneumothorax

  4. For small pneumothorax, oxygen and observation are appropriate.  For large pneumothorax, tube thoracostomy is indicated.