title: Loculated pneumothorax due to a rare combination resulting in an interesting chest radiograph.
abstract: A 35 years old man presented with acute onset left sided pleuritic chest pain and shortness of breath. On evaluation, he was found to have an interesting chest radiograph which showed a loculated pneumothorax with collapse of the left upper lobe and lingula but fully expanded left lower lobe. He is a known asthmatic who had allergic broncho pulmonary aspergillosis (ABPA) previously with left upper lobe and lingular collapse secondary to mucous plugging. This resolved on treatment with steroids and itraconazole. An interesting combination of events is proposed to explain the current presentation. CT scan chest and blood tests confirmed this sequence of events. He was appropriately treated resulting in complete clinical and radiological recovery. The events leading to the presentation and the likely physiological background for this interesting chest radiograph are discussed.
authors.affiliation: Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon United Kingdom.
authors.forename: Barney Thomas Jesudason
authors.initials: BTJ
authors.lastname: Isaac
authors.affiliation: Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon United Kingdom.
authors.forename: Johnson Thamarathu
authors.initials: JT
authors.lastname: Samuel
authors.affiliation: Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon United Kingdom.
authors.forename: Dipak K
authors.initials: DK
authors.lastname: Mukherjee
authors.affiliation: Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Pittman
mesh_terms: D000328:Adult; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000188:drug therapy; D002637:Chest Pain / Q000175:diagnosis; D004417:Dyspnea / Q000175:diagnosis; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000473:pathology; D001261:Pulmonary Atelectasis / Q000209:etiology; D011859:Radiography / Q000379:methods; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D017964:Itraconazole
keywords: ABPA; interesting chest radiography; loculated spontaneous pneumothorax; mucous plugging; preferential lung collapse