Chest X-ray - Scenario 3
Answers to scenario questions

Answers to scenario questions

Question 1

Regarding image 2 - what procedure has been performed and what complication has occurred?

• There is a pneumothorax secondary to chest drain insertion

Question 2

Regarding image 2 - what clinical signs could you expect to find on examination?

• Tachypnoea/Tachycardia/Cyanosis/Hypotension
• Asymmetric thoracic expansion (reduced on right)
• Hyper-resonant percussion note (right)
• Reduced tactile and vocal fremitus (right)
• Absent breath sounds (right)

Question 3

What do you think could be the cause of her abdominal distension?

• Ascites/Peritoneal disease (common in ovarian carcinoma)
• Hepatomegaly due to liver metastases is an acceptable answer but is much less likely

Question 4

What is the best initial imaging examination to investigate her abdomen?

• Ultrasound is the best initial investigation especially if the patient is uncomfortable and drain insertion or aspiration is being considered
• CT is required for full staging but is not the initial investigation to help manage the distension

Question 5

Which laboratories should receive a sample of the pleural fluid removed and in general terms - what results would you expect?

• Histopathology (for cytology), biochemistry (for protein/LDH), microbiology (for gram stain, culture and sensitivity)
• Given the history, this unilateral effusion is likely to be an exudate, containing malignant cells (or lymphocytes), and no organisms