pearljam59
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A previously healthy 30-year-old man comes to the emergency department because of the sudden onset of right shoulder pain and shortness of breath. Breath sounds are absent over the right lung. His cervical trachea at the superior sternal border is shifted to the left. The most likely cause of his condition is rupture of which of the following?
A. Anterior hernia
B. Apical pulmonary bleb
C. Bronchial diverticulum
D. Cystic adenomatoid malformation
E. Posterolateral hernia
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| doc179
Forum Guru
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B
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| druas
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B...pneumothorax
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| pearljam59
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I figured it is pneumothorax with the absent breath sounds on right and tracheal deviation to LEFT but what is a bleb that can rupture and cause a hole in lung?!
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| druas
Forum Elite
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its an emphymatous bulla that ruputred
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| robin082006
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agree
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| sosikan
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why not c ?wasnt it a shift?
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| jagian75
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how will one explain the rt shoulder paindue to phrenic nerve
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| fleuve
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can anybody tell me waht is pulmonary bleb
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| doc179
Forum Guru
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pulmonary bleb. This is a weakness and out-pouching of the lung tissue, which can rupture. This introduces air into the pleural space.
check out the link below about pneumothorax
http://adam.about.com/surgery/100150.htm
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| giovanni83
Forum Senior
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yes b. it's typical the rupture of this bleb in healty and young indiviuduals...it's a problem of young and "sane" people....it's genetic
(the other class of people interested by this problems are emphisematous old people, but in this casae it's not genetic)
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| fleuve
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thank you doc197
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| Geroo
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isn't rupture pulmonary bleb would leads to lung collapse and shift of trachea to the same side(right side)?
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| giovanni83
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the trachea shifts in either direction, depending on expiration or inspiration
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| ManuNastai
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Geroo: a normal pneumothorax goes like you said, with colapse of the lung on the same side (decreased percusion, increased tactile fremitus, absent respitatory sounds, asincronism, asymetry of hemithoraxes) and on the roentgen it shows a elevated diafragm on the same side and the mediastinal stuff go on the same side.
but this is a particular pneumothorax: it's a TENSION pneumothorax in which the guy can inspire (at first) and the air gets into his pleural cavity and can't get it out. so all that air shifts all the mediastinal stuff (including tracha) on the opposite side, and on Phy ex. shows tympanism, absent tactile fremitus, absent respiratory movements on the hemithorax involved, cyanosis, bulging of the supraclavicular fosa and intercostal spaces, absent respiratory sounds and it's a medical emergency!!!
it's good to hear what prof. goljan has to say about it 'cause he sais it right!! yo'll rememer everything after you listen to him
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| Geroo
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thanks manunastai,
but I think this case isn't tension pneumothorax.tension pneumothorax occurs with peneterating chest trauma.rupture pulmonary bleb leads to spontaneous pneumothorax.
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