Localized Hyperlucency in an Acutely Dyspneic Patient: Always a Pneumothorax?

Publication date: Available online 27 May 2016
Source:The Journal of Emergency Medicine
Author(s): Ruchi Dua, Ankit Singhal
BackgroundEvery emergency physician encounters acutely dyspneic patients with localized hyperlucency on chest x-ray study. Although most commonly due to pneumothorax, alternative diagnosis in selected cases with atypical features includes bullae and cystic lesions, especially in childhood. Presence of atypical radiology shouId alert an emergency physician to rule out any alternative diagnosis. Computed tomography is usually diagnostic in such cases and a double-wall sign on computed tomography aids to distinguish between pneumothorax and bullous disease.Case ReportA 60-year-old male presented with sudden increase in dyspnea and a localized hyperlucency on chest x-ray study. A review of his medical records and evaluation of atypical radiology by computed tomography revealed increase in size of bulla to be the cause for distress rather than a pneumothorax.Why Should an Emergency Physician Be Aware of This?Every emergency physician encountering acutely dyspneic patients should be aware of these potential mimickers of pneumothorax and ways to distinguish them to avoid inadvertent tube thoracostomy and possible complications.



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