title: When is a pneumothorax not a pneumothorax?
abstract: The authors report on a 13-year-old boy who, after exercise, had respiratory distress and left upper quadrant abdominal pain. Initially, a mistaken diagnosis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x-ray in the left hemithorax. He underwent a laparotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior was felt to have contributed. A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.
authors.affiliation: Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
authors.forename: Sinead
authors.initials: S
authors.lastname: Harte
authors.forename: Rowan G
authors.initials: RG
authors.lastname: Casey
authors.forename: Des
authors.initials: D
authors.lastname: Mannion
authors.forename: Martin
authors.initials: M
authors.lastname: Corbally
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D015505:Chest Tubes; D003108:Colonic Diseases / Q000209:etiology; D003951:Diagnostic Errors; D004417:Dyspnea / Q000209:etiology; D004942:Esophagitis, Peptic / Q000601:surgery; D005538:Football; D018662:Fundoplication; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal; D007813:Laparotomy; D008297:Male; D010994:Pleura; D011030:Pneumothorax / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D013158:Splenic Diseases / Q000209:etiology; D013272:Stomach Diseases / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D019564:Unnecessary Procedures