Pulm Misc and Imaging


After fall, has chest pain, and SOB. CXR is as below. What is the cause? What to do next. 

  • Spontaneous 
    • Primary Spontaneous
      • No Prior Lung Disease 
      • <2-3 cm: NC Oxygen and observation
      • >2-3 cm: Needle aspiration
      • Symptomatic: Needle aspiration . 
      • When needle aspiration fails in above - Tube thoracostomy. May need thoracoscopy as well. 
      • Recurrent PSP or with hemothorax: Needs thoracoscopy.
      • If thoracoscopy not available. Then pelurodesis can be considered. 
      • Clinically unable. Tube thoracostomy. 
    • Secondary Spontaneous
      • Presence of Prior Lung Disease 
      • Carries increased risk of adverse outcome. Hence, all patient should be hospitalized except for cystic fibrosis with < 1 cm 
      • Oxygen for all
      • Large > 2 cm: Tube thoracostomy
      • Small 1 -2 cm: Small bore chest tube
      • Very small < 1 cm: Observation
  • Traumatic 
Mucous Plug