A Case of Missed Giant Bullae Emphysema Diagnosed as Pneumothorax

We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.

Primary spontaneous haemopneumothorax: An overlooked emergency.

Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.