Case Report
A 22-year-old man who was a known heroin abuser was admitted toan emergency department comatose, with shallow respirations.Routine laboratory studies and chest x-ray studies were done afterthe patient was aroused. He was then transferred to the ICU. Hecomplained of left-sided chest pain. Examination of the chest filmshowed three fractured ribs on the right and a large right pleuraleffusion. Further questioning of a friend revealed that he hadfallen and struck the corner of a table after injecting heroin.
The diagnosis was traumatic hemothorax secondary to ribfractures and a chest tube was inserted into the right pleuralspace. No blood could be obtained despite maneuvering of the tube.Another chest x-ray showed that the tube was correctly placed inthe right pleural space, but the fractured ribs and the pleuraleffusion were on the left. The radiologist then realized that hehad reversed the first film. A second tube was inserted into theleft pleural space, and 1500 ml. [6 to 7 cups] of blood wasevacuated.
- What did the initial chest x-ray show? _____
- Collapsed lung
- Shallow respirations
- Pleuodynia
- Collection of fluid between the pleura
- What term indicates that the condition was caused by fracturedribs?
- Secondary
- Comatose
- heroin
- Effusion
- What procedure was used to relieve the condition? ____
- Chest x-ray
- Thoracotomy and tube insertion
- Paracentesis
- Pericardiocentesis
- What is the lesson from this case report? _____
- Get a chest x-ray immediately upon entering the ED?
- Removal of the fluid from the pleural space showed no blood waspresent
- Be sure that a chest x-ray is read correctly
- Be careful when injecting heroin
