A 65-year-old man with a 40-pack-year smoking history and known emphysematous changes on prior imaging presents to the emergency department with acute-onset pleuritic chest pain and dyspnea that developed while watching television. He reports no recent illness or leg swelling. Vital signs: BP 138/85 mmHg, HR 112 bpm, RR 28/min, O2 saturation 88% on room air. Physical examination reveals decreased breath sounds and hyperresonance to percussion on the right hemithorax, with normal vocal fremitus. Trachea is midline. Chest X-ray demonstrates a right-sided visceral pleural line separated from the chest wall with absent lung markings peripherally. Which of the following best explains the mechanism of this patient's acute decompensation?
- A)Rupture of a subpleural emphysematous bleb with air leak into the pleural spaceGABARITO
- B)Acute bacterial infection with formation of a loculated parapneumonic effusion
- C)Pulmonary embolism with acute right ventricular strain and cor pulmonale
- D)Spontaneous hemothorax from erosion of an intercostal artery by emphysematous changes
- E)Acute exacerbation of COPD with right mainstem bronchus mucus impaction and atelectasis
Explicação
The clinical presentation—sudden onset dyspnea at rest, pleuritic chest pain, hypoxia, decreased breath sounds with hyperresonance, and a visceral pleural line on imaging—is pathognomonic for spontaneous pneumothorax. In COPD patients with emphysema, subpleura... Ver explicação completa e trilha adaptativa →