A 29-year-old man presents to the emergency department with new-onset dyspnea and right-sided chest pain. He is tall and thin, his vital signs are within
... [Show More] normal limits except for an oxygen saturation of 92%, and chest X-ray reveals a pneumothorax with a 3.5 cm rim of air in the right pleural space. Which of the following represents the best initial treatment for this patient?
A. Chest tube thoracostomy
B. Needle aspiration
C. Supplemental oxygen and observation
D. Video-assisted thoracoscopic surgery - correct answer ✔✔B. Needle aspiration
Patients may also be asymptomatic with the pneumothorax found incidentally on chest X-ray. Physical exam findings include decreased chest excursion, hyperresonance to percussion, and decreased breath sounds on the affected side. Patients who have a tension pneumothorax may also present with tachycardia and hypotension, necessitating immediate life-saving thoracostomy. If vital signs are stable, patients with a spontaneous pneumothorax greater than 3 cm or who are symptomatic can be treated with needle aspiration of the pneumothorax. The aspiration is performed with an 18 gauge needle in the second or third intercostal space at the midclavicular line. A catheter is inserted, and air is removed completely. If there appears to be a persistent leak, tube thoracostomy and thoracoscopy with pleurodesis are required. A pneumothorax can be definitively diagnosed with a chest X-ray, and serial chest X-rays are also used to gauge treatment effectiveness and lung reinflation. Recurrence of spontaneous pneumothorax can be diminished with smoking cessation and pleurodesis.
A 57-year-old female presents to the emergency department with a worsening cough, shortness of breath, and night sweats. In addition, the patient has experienced a 10 lb weight loss over the past 2 months despite having made no changes to her diet. She was recently released from incarceration and smokes one pack of cigarettes per day. Past medical history is notable for hypertension and hyperlipidemia. The patient was born in Mexico and had a positive PPD test as an adolescent. Chest x-ray is demonstrated below.
Which of the following best describes the radiographic finding above?
A. Calcif [Show Less]