Pneumothorax, significance of X-ray in ER: Report of two cases

Abstract

INTRODUCTION: Pneumothorax is abnormal collection of air in the pleural space occurring when there is discontinuity between visceral and parietal pleura. When communication between bronchi, alveololi and pleural cavity occurs, atsmopheric and intrapleural pressure are being equalized, which lead to decrease in lung compliance thus causing collapsed lung. Collapsed lung can be partial and complete. Pneumothorax can be primary spontaneous, secondary spontaneous and traumatic. CASE PRESENTATION: We have shown two patients, bot with primary spontaneous pneumothorax, without previous chest trauma, without primary pulmonary disease, that were diagnosed with pneumothorax radiographically in ER. In first case, 20 y/o male presented in ER with chest pain and dyspnoea. He was smoker. Said symptoms occurred for the first time. Auscultatory, breath sounds were inaudible. After x-ray of the chest were performed, there were detected presence of gas collection in the left apical zone, with collapsed lung parenchyma. Toracal drainage catheter were inserted, thus making possible for reexpansion of collapsed lung and patient, with stable condition, was transferred to the internal medicine ward.In the second case, patient 56 y/o was presented, who had spontaneous recurrent pneumothorax and called for an ambulance because of breathing difficulty which he had had for two days. Auscultatory, breath sounds were diminished. Righ-sided pneumothorax was detected after chest x-ray was performed in ER. Thoracic drainage catheter was inserted, collapsed lung reexpanded and in stable condition, patient was discharged after five days. CONCLUSION: Cases that were demonstrated can point out the fact that auscultatory findings can not with certainty indicate pneumothorax. Radiography, which can reveal partial or complete collapsed lung, along with blood gas analysis which are important for evaluation of the disturbed lung functions, are of the great importance for the treatment of this condition