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[Pneumothorax revealed by postoperative computed tomography]
Shizuka Ikeda1, Kiyoshi Katori, Minoru Fujimoto
1Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka 814-0180.
Masui. the Japanese Journal of Anesthesiology
|November 22, 2005
Summary
A case of pneumothorax was discovered after surgery using computed tomography. This condition was not visible on a chest X-ray, highlighting CT scans for diagnosing subtle postoperative complications.
Area of Science:
- Medical Imaging
- Anesthesiology
- Trauma Surgery
Background:
- A 39-year-old obese female patient sustained multiple fractures from a traffic accident, necessitating surgical osteosynthesis.
- The patient's anesthesia involved thiopental, nitrous oxide, oxygen, and sevoflurane, with a notable intraoperative oxygen saturation (Spo2) decrease.
Observation:
- Intraoperative Spo2 dropped from 99% to 94%, despite symmetrical bilateral chest sounds.
- Postoperative chest X-ray did not reveal pneumothorax, but computed tomography (CT) of the chest identified a right-sided pneumothorax.
Findings:
- Computed tomography is crucial for diagnosing postoperative pneumothorax, especially when chest X-rays are inconclusive.
- An electrocardiogram (ECG) electrode potentially obscured a fractured rib on the preoperative chest X-ray, contributing to the missed diagnosis.
Implications:
- This case underscores the importance of advanced imaging like CT scans in identifying subtle postoperative complications.
- Clinicians should consider potential artifact or misinterpretation on initial radiographic assessments in trauma patients.
- Enhanced vigilance in interpreting imaging post-trauma and surgery is recommended for optimal patient outcomes.