case of week 1

1. A 30 year old with asthma presents after suddenly developing
dyspnoea several days into a chest infection with worsening
wheeze. He has never had this before in an asthma attack, and there
is no pain, or fever. On exam, the most notable feature is SaO2
88%.
•What do you think is going on in the chest x-ray shown?
•Does this happen in asthma attacks?
•What investigation and treatment is required?

3. Most of us would expect to see a significant pneumothorax
given the clinical story…but that is NOT what we find.
This patient has a right middle lobe collapse, visible on the
PA chest as a blurring of the right cardiac silhouette, and on
the lateral as a dense ‘sail’ sign.
Asthmatics do get atelectasis, as a result of airway
narrowing and excessive production of secretions. A chest
drain would be a bad idea for this patient, who needs
intensive chest physiotherapy in addition to the normal
medications provided to an asthmatic.