Notice that what it seems to be a right pneumothorax is actually bullae on the CT scan. Let pneumothorax is under pressure and chest tube was inserted!
However, on the CT scan taken post chest tube insertion, it seems that the tube is introduced into the lung!
It seems that these are lung bullae, but chest x-ray was completely normal 5 days ago and turned out to be loculated pneumothorax.
Most patients with bullae have a significant cigarette smoking history, although cocaine smoking, pulmonary sarcoidosis, alpha1-antitrypsin deficiency, 1-antichymotrypsin deficiency, Marfan's syndrome, Ehlers-Danlos syndrome and inhaled fiberglass exposure have all been implicated.
Types of surgery for bullous emphysema include: Bullectomy. Your surgeon removes the bullae from your lungs using open surgery (thoracotomy) or a minimally invasive procedure (video-assisted thoracic surgery). Bronchoscopic lung volume reduction (BLVR).
Occasionally, giant bulla may be mistaken for a pneumothorax by a chest radiograph. In general, the pleural line associated with a large bulla is usually concave to the lateral chest wall, whereas the pleural line associated with a pneumothorax is convex.
Bullae occur in various clinical contexts: (1) with emphysema (“bullous emphysema”); (2) with pulmonary fibrosis, as in the late stages of sarcoidosis or complicated pneumoconiosis; (3) in so-called “vanishing lung,” in which the parenchyma is rapidly replaced by multiple bullae as in above case and (4) in lungs that are otherwise ...
In pulmonary TB , bullae are rare.
In SAR-CoV-2 , lungs bullae are reported in the literature and should be investigated for it if 5 says ago CxR was reported normal.
Bilateral apical pneumothoraces, approximately 10% in size on the right and 20-30% on the left without mediastinal shift with diffuse alveolar infiltrates and air bronchograms.
Was the chest tube draining anything?