A 79-year-old nonsmoking woman developed idiopathic interstitial pneumonia treated with systemic steroids (10-mg/day prednisone). Follow-up chest X-ray (CXR) showed a hyperlucent right lung (Picture A, black arrows). One week later, CXR showed a new hyperlucent left lung (Picture B, white arrows). She did not complain of chest pain or dyspnea. Chest computed tomography (CT) demonstrated mediastinal and paravertebral emphysema, right-sided air collection without web-like opacities (pneumothorax; Picture C), and left-sided air collection with web-like opacities (black arrowheads), whereas white arrowheads showed the mixture of the visceral and parietal pleura (intrathoracic extrapleural air collection; Picture D, E). Two months later, follow-up chest CT demonstrated the improvement of these features without any treatment (Picture F-H). Air collection in the intrathoracic extrapleural space, including the extrapleural fat, endothoracic fascia, and innermost intercostal muscle, can be mistaken for pneumothorax if assessed only by CXR images (1). Therefore, inserting chest tubes should be carefully considered.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Sakai M, Hiyama T, Kuno H, et al. Thoracic abnormal air collections in patients in the intensive care unit: radiograph findings correlated with CT. Insights Imaging 11: 35, 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]