A 36-year-old woman with a history of obstructive sleep apnea is admitted with acute shoness of breath, cough with greenish sputum, and fever. On physical examination, she is febrile and has decreased breath sounds generally and diffuse bilateral rhonchi. ABGs: pH 7.32; PCO2 47 mm Hg; PO2 65 mm Hg with O2 saturation 87%.The patient improves initially but has a respiratory arrest as she is being moved to the ICU, requiring emergency endotracheal intubation. While a CXR is ordered, it is noted that she has absent breath sounds on the left side. CXR shows
The chest radiograph shows a homogeneous opacity occupying the left hemithorax with no air bronchograms. The left hea border and left diaphragm are not seen, consistent with left lung atelectasis. The right upper zone parahilar area is also paially opacified, suggesting paial right upper lobe atelectasis. An endotracheal tube is seen extending down to the right intermediate bronchus. This patient was admitted with symptoms of pneumonia with hypoxemia and respiratory acidosis. Initial treatment should include controlled oxygen therapy, antibiotics, and aerosolized bronchodilator therapy. IV theophylline is not considered standard practice and is not a first-line drug for bronchospasm. During CPR and resuscitation, traumatic pneumothorax and pneumomediastinum can occur. The CXR shows left-sided atelectasis with the endotracheal tube placed distally in the right intermediate bronchus. Correct positioning of the tube above the carina should be the first step in this case.
Left pneumothorax
Pneumomediastinum with esophageal rupture
Left pleural effusion
Atelectasis
Fundamentals in Radiology