“The lung is up ...”

A 54 year old man presented to a district hospital with left sided pain and shortness of breath. He had been a heavy smoker till 5 years before. Chest Xray showed a left sided pneumothorax. A well placed apical drain resulted in re-expansion of the lung. The drain was removed 5 days later and the patient discharged.


He returned 10 days after feeling unwell and more breathless.

On examination, he was not breathless at rest but had a "gray look" about him. Leucocyte count 17.4, C reactive protein 354 but afebrile. The chest Xray was said to show that "the lung is up but there is a bit of fluid at the left base..."

He was referred to the regional thoracic unit as a loculated empyema.

CT scan showed that despite the chest Xray appearances there was an anterior pneumothorax. It also showed consolidation of the lower lobe and a slightly loculated effusion at the left base.

A chest drain was inserted via the left axilla with the tip of the drain lying anteriorly. The lung expanded fully but an air leak persisted for 3 days.

There was no growth after 48 hours culture of the pleural fluid.

As this is a secondary pneumothorax due to chronic airways disease prophylaxis is recommended. Talc pleurodesis (slurry via chest drain) was perfomed.