A Case of Missed Giant Bullae Emphysema Diagnosed as Pneumothorax
Bullae Misdiagnosed as a Pneumothorax
Abstract
We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min andSpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Keywords :
emphysema,
haemopneumothorax,
thoracostomy,
thorax,
Abstrak
Kami melaporkan kes emfesema bullous gergasi yang disalah diagnos sebagai pneumotoraks. Seorang lelaki perokok kronik berusia 18 tahun hadir dengan sakit dada sebelah kanan dan sesak nafas. Kadar pernafasan adalah 35/min, tekanan darah 139/90 mmHg, kadar nadi 80/min dan SpO2 pada udara bilik adalah 98%. X-ray dada ditafsir sebagai pneumotoraks spontan. Aspirasi jarum telah dijalankan tetapi keadaan pesakit merosot. Kemudian tiub dada torakostomi dilakukan. Selepas itu, berlaku pendarahan di dalam toraks. Keadaan pesakit merosot. CT toraks telah dilakukan dengan segera dan menunjukkan bahawa terdapat hemopneumotoraks dengan banyak bullae. Pesakit telah digegaskan ke bilik pembedahan untuk torakostomi. Pengajaran yang boleh dipelajari daripada kes ini adalah bahawa bullae emfesema gergasi boleh menyamar sebagai pneumotoraks dan perhatian lebih perlu sebelum torakosintesis dilaksanakan.
Kata Kunci :
emfesema,
hemopneumotoraks,
torakostomi,
toraks,
Correspondance Address
Nik Azlan Nik Muhamad, Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455703 Fax: +603-91456577 E-mail: nikazlanmuhamad@hotmail.com
