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Roentgenogram of the Month |

A 16-Year-Old With Left-sided Pneumothorax*

Cyprian Mendonca, MD; Liam Lynch, MD
Author and Funding Information

*From the Birmingham Heartlands and Solihull Hospital NHS Trust, Birmingham, UK.



Chest. 1999;115(3):881-882. doi:10.1378/chest.115.3.881
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A 16-year-old boy with features of Marfan’s syndrome, previously in good health, had left sided chest pain and dyspnea of 6 days’ duration, which had worsened considerably on the day of admission. A posteroanterior chest radiograph showed complete pneumothorax on the left side and a partial pneumothorax on the right side. A chest tube was inserted on the left side and connected to an underwater seal drain. The patient became more dyspneic immediately. A repeat chest radiograph showed air space shadowing over the entire left lung field and an increase in the size of the pneumothorax on the right side (Fig 1) . Subsequently, another chest drain was inserted on the right side and connected to an underwater sealed drainage. No negative pressure was applied to either of the drains. Over the next 30 min, the patient’s BP dropped to 70/50 mm Hg, and his oxygen saturation was recorded at 70% by pulse oximetry. Arterial blood gas analysis showed a PaO2 of 7.7 kPa and saturation of 90% while breathing 35% oxygen via face mask. Further chest radiographs revealed increasing air space shadowing over the rest of the left lung field with complete expansion of both lungs. Arterial BP initially responded to transfusion of IV fluids, but the patient remained hypotensive despite the administration of 1.5 L of IV gelatin solution.

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