case of the week 2

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.