case_images: PMC11785421_01
case_images: Chest radiograph following chest tube placement. Emergency department chest radiograph after chest tube placement (red star), showing extensive bilateral lung opacities and a persistent right-sided pneumothorax (yellow star).
case_images: cureus-0017-00000076756-i01.jpg
case_images: PMC11785421_01_cureus-0017-00000076756-i01.jpg
case_images: FIG1
case_images: An 18 French chest tube was inserted in the fifth intercostal space in the midaxillary line, using a blunt dissection technique (Figure 1), and connected to an underwater seal drainage system with visible bubbling.
case_images: Coronal chest CT scan image. Coronal image showing an extensive right-sided pneumothorax (yellow star) with lung atelectasis (blue star) and small cavitations visible in the left lung (red arrows).
case_images: cureus-0017-00000076756-i02.jpg
case_images: PMC11785421_01_cureus-0017-00000076756-i02.jpg
case_images: FIG2
case_images: Following this, a CT scan of the chest revealed multiple peribronchovascular nodules in the left lung, predominantly in the upper lobes, with some cavitated lesions, the largest measuring 13 mm (Figure 2, red arrows). A large-volume pneumothorax (Figure 2, yellow star) was observed on the right side, accompanied by a small-volume pleural effusion and near-complete atelectasis of the right lung (Figure 2, blue star).
case_images: Axial chest CT scan image. Axial image showing correct chest tube placement (red arrow) with persistent pneumothorax.
case_images: cureus-0017-00000076756-i03.jpg
case_images: PMC11785421_01_cureus-0017-00000076756-i03.jpg
case_images: FIG3
case_images: TB. The chest tube was confirmed to be well-positioned (Figure 3, red arrow) and still bubbling, raising suspicion for the presence of a BPF.
case_images: Chest radiograph during SLV. Chest radiograph showing correct placement of a left-sided double-lumen tube (red arrow).. SLV, single-lung ventilation
case_images: cureus-0017-00000076756-i04.jpg
case_images: PMC11785421_01_cureus-0017-00000076756-i04.jpg
case_images: FIG4
case_images: Following the decision to proceed with a conservative approach and after the failure of noninvasive methods to correct hypoxia, the patient was intubated with a 35 French double-lumen endotracheal tube (DLET) and placed on single-lung ventilation (SLV) of the left lung to manage the significant air leak and respiratory compromise (Figure 4).