case_images: PMC10799245_01
case_images: AP supine chest radiograph showing right-sided pneumothorax.
case_images: rjad732f1.jpg
case_images: PMC10799245_01_rjad732f1.jpg
case_images: f1
case_images: Chest X-ray (CXR) revealed a right-sided pneumothorax (Fig. 1) that was treated with a small-bore pigtail chest tube and resulted in immediate improvement of her tension physiology.
case_images: AP upright chest radiograph showing placement of right-sided chest tube and resolution of right pneumothorax.
case_images: rjad732f2.jpg
case_images: PMC10799245_01_rjad732f2.jpg
case_images: f2
case_images: The pneumothorax resolved on repeat chest film while the patient remained intubated and sedated (Fig. 2).
case_images: AP upright chest radiograph showing intraabdominal free air, right-sided chest tube in place, and bilateral chest wall subcutaneous emphysema that is worse on the right. Bilateral patchy airspace disease is noted as well.
case_images: rjad732f3.jpg
case_images: PMC10799245_01_rjad732f3.jpg
case_images: f3
case_images: On Hospital Day 2, an interval CXR showed continued resolution of the right-sided pneumothorax but worsening subcutaneous emphysema of the bilateral chest wall and pneumoperitoneum (Fig. 3).
case_images: Post-operative chest radiograph showing increased diffuse subcutaneous emphysema in chest, lower neck and upper left abdominal wall. Previously demonstrated pneumoperitoneum is not visualized on the current film.
case_images: rjad732f4.jpg
case_images: PMC10799245_01_rjad732f4.jpg
case_images: f4
case_images: Immediate post-op CXR no longer showed evidence of pneumoperitoneum (Fig. 4).
case_images: Laparoscope revealing emphysematous changes within the gastrohepatic ligament.
case_images: rjad732f5.jpg
case_images: PMC10799245_01_rjad732f5.jpg
case_images: f5
case_images: In the abdomen, emphysematous changes within the gastrohepatic ligament and omental adhesions to the anterior abdominal wall were visualized (Figs 5 and 6).
case_images: Laparoscope of the anterior abdominal wall revealing emphysematous changes within the preperitoneal space.
case_images: rjad732f6.jpg
case_images: PMC10799245_01_rjad732f6.jpg
case_images: f6
case_images: In the abdomen, emphysematous changes within the gastrohepatic ligament and omental adhesions to the anterior abdominal wall were visualized (Figs 5 and 6).
case_images: Laparoscope of the large bowel revealing subserosal emphysema within the adventitia.
case_images: rjad732f7.jpg
case_images: PMC10799245_01_rjad732f7.jpg
case_images: f7
case_images: Laparoscopic exploration revealed no diaphragmatic injury or perforated viscera but identified emphysematous changes throughout the preperitoneal space, small and large bowel mesentery, and right paracolic gutter (Figs 7 and 8).
case_images: Laparoscope of the right paracolic gutter revealing emphysematous changes of the mesentery.
case_images: rjad732f8.jpg
case_images: PMC10799245_01_rjad732f8.jpg
case_images: f8
case_images: Laparoscopic exploration revealed no diaphragmatic injury or perforated viscera but identified emphysematous changes throughout the preperitoneal space, small and large bowel mesentery, and right paracolic gutter (Figs 7 and 8).