Case
A 21-year-old male with Ehlers-Danlos type IV (EDS IV) presented to the emergency department with sudden onset right-sided pleuritic chest pain.
On examination, some of the typical features of EDS IV including large eyes and small chin were noted, although other features such as sunken cheeks, thin nose and lips, and lobeless ears were not noted [1]. His respiratory rate was 20 breaths·min−1, saturations were 93% on air increasing to 98% on 28% oxygen via a venturi mask. Pulse was 115 beats·min−1 in sinus rhythm and his blood pressure was 112 over 64 mmHg.
There was decreased air entry in the right hemithorax, with decreased vocal resonance. The trachea was central and there was no surgical emphysema.
Task 1
1. What is the best description of the chest radiograph (fig. 1)?
Chest radiograph on admission.
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A right-sided tension hydro-pneumothorax
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A right-sided hydro-pneumothorax
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A right-sided cavitatory pneumonia
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A right-sided pneumo-peritoneum
2. What would the next therapeutic step be?
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Simple observation and high flow oxygen
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Aspiration of pneumothorax
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Insertion of a small 12-French bore Seldinger chest drain
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Insertion of a large-bore chest drain
Answer 1
The chest radiograph shows a right-sided hydro-pneumothorax and the next therapeutic step would be insertion of a small 12-French bore Seldinger chest drain.
Local anaesthetic was instilled into the second intercostal space and it was possible to aspirate air via the green needle. A 12 French intercostal drain was inserted using the Seldinger technique with no immediate complications and connected to an underwater seal bottle which …
