Radiology Review

When the Fix Fails

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When the Fix Fails image

A 60-year-old woman is transferred to your facility from an outside hospital for tertiary care. She was reportedly at home with family when she suddenly collapsed and became unresponsive. She was taken to a nearby hospital, where she was resuscitated, stabilized, and urgently sent to your facility for possible cardiac intervention.

You assess the patient immediately upon arrival;with no family present, history is limited to the chart. You note an intubated female on mild sedation. Her vital signs include a temperature of 37.0°C; blood pressure, 130/80 mm Hg; heart rate, 70 beats/min; and O2 saturation, 98% on 100% FiO2.

The heart rate monitor shows sinus rhythm. A right chest tube is in place. Auscultation reveals bilateral rhonchi.

Portable chest radiograph is obtained (shown). What is your impression?


When the Fix Fails image


The radiograph shows an adequately positioned endotracheal tube. It also shows bilateral infiltrates, greater in the right than in the left lung.

A pigtail catheter is present, up high near the apex; despite this, a pneumothorax of moderate size remains on the right. The likely explanation is that the catheter is either not properly positioned or is kinked.

Prompt surgical consultation for new chest tube placement was obtained.

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Acute Management of Severe Asymptomatic Hypertension

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