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Radiology Image: A cramped feeling

A cramped feeling

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Presentation

A 66-year-old man presented with acute respiratory disfunction a few days after he completed his 3 week antibiotic treatment for a Legionella pneumonia located in the right lung. An X-ray showed that the right lung was compressed (Figure 1). Based upon these findings a chest drain was placed, 1,5 L of fluid was drained, and the drain was left in situ. Clinically, the patient improved significantly, had a lower work of breathing and required less O2-support, though he still felt cramped. During physical examination breath sounds on the lower right side were reduced and a new X-ray was made (Figure 2).

X-ray made a few days after completing antibiotic treatment for a Legionella pneumonia in search of the cause of the acute respiratory distress. The complete right lung is compressed by the consolidation.

X-ray made to objectify the clinical improvement of the patient after leaving the drain in situ, but also to find a cause for the cramped feeling and findings during physical examination.

Question about the X-rays.

M. Nazir & M. Hollmann

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a) Conservative, there is already a major decrease in pleura fluid

This is not the correct answer. The drain was placed 10 days ago and although there was some clinical improvement, the current clinical situation still indicates there is the need for additional intervention.

b) Pharmacological treatment

This is not the correct answer. Treating the patient again with antibiotics would not improve the patient’s clinical condition. It could be that the patient has a new infection, but this is less likely after the completion of antibiotic treatment, and the clinical improvement after chest drainage.

c) Retraction of the drain to resorb the last amount of pleural fluid

This is the correct answer. A clear water-air separation is seen where the tip of the drain ends, indicating that the last amount of pleural effusion can only be removed by a correct located drain.

d) Intubate the patient

This is not the correct answer. Intubation of the patient will not resolve the problem of the wrong position of the drain.

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