15/11/2024
This lucky girl had an interesting few days. After going for a run she had a persistent increase in her respiratory rate.
On exam she was struggling a bit with poor lung sounds over the left chest. Ultrasound confirmed the lung was not against the chest wall, and the space was filled with air.
On xray we could not see an obvious reason and soon after this she decompensated suddenly and we began draining her chest of air. Except the air kept coming which meant she had a leak in her respiratory tract into her chest cavity creating a tension pneumothorax.
We were struggling to get on top of it so we moved to surgery to find the leak and we found a 3mm hole in one of the lung lobes. Even under ventilation we were struggling to inflate her left lungs well. Once we isolated and clamped off the area to resect, her lungs inflated and she stabilised so this was definitely the culprit!
We resected the lesion, which we suspect to be a ruptured bulla (pathology pending), which are kind of blisters on the lung that can spontaneously rupture.
Today she is much happier, stable off oxygen and looking good! Definitely a hairy case for a bit there, but an interesting one!