Post-op complications of a left nephrectomy
Post-op complications of a left nephrectomy, XR - Plain Film
Demographics
53 y.o. male
Caption
PA upright chest - there is an area of lucency noted in the apical left lung above a well-defined pleural line that is devoid of pulmonary vasculature.
Plane
PA
Modality
XR - Plain Film
ACR Codes
6.4
( This image was added on 2006-11-14 )
Quiz
case
Post-op complications of a left nephrectomy: 1. left apical pnuemothorax 2. pneumomediastinum 3. pneumoperitoneum 4. left lower lobe infiltrate with effusion 5. subcutaneous emphysema
History
53 y/o maln s/p left nephrectomy
Exam
Unknown
Findings
1. left apical pnuemothorax 2. pneumomediastinum 3. pneumoperitoneum 4. left-sided pleural fluid collection, and likely compressive atelectasis of left lower lobe 5. subcutaneous emphysema
Case Diagnosis
Post-op complications of a left nephrectomy: 1. left apical pnuemothorax 2. pneumomediastinum 3. pneumoperitoneum 4. left lower lobe infiltrate with effusion 5. subcutaneous emphysema
Discussion
Pneumothorax-a small pneumothorax such as this should be reabsorbed with a matter of days. Larger pneumothoraces may take 2-4 weeks if the defect allowing air into the pleural space is not renewed. In the absence of marked thickening of pluera or pulmonary fibrosis, delayed absorption should suggest the possibility of bronchial obstruction (e.g.mucus plug). Etilogies of a pneumothorax are numerous, frequently iatrogenic from the retroperitoneal area. Pneumomediastinum-can be caused by a surgical procedure in the retroperitoneal area with cephalad migration of air along contiguous fascial planes. Pneumomediastinum occurs frequently following diagnostic retroperitoneal air insufflation. It can also result from a pneumoperitoneum. Air may be introduced inadvertantly into the properitoneal tissue or it may enter this plane by seepage from the peritoneal cavity.The air in the properitoneal region courses upward deep to the abdominal muscles and between the diaghragm and the parietal peritoneum which covers its undersurface. From here, it may enter the mediastinum through one of the natural openings in the diaphragm.
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topic
Post-op complications of a left nephrectomy
Disease Discussion
Pneumothorax-a small pneumothorax such as this should be reabsorbed with a matter of days. Larger pneumothoraces may take 2-4 weeks if the defect allowing air into the pleural space is not renewed. In the absence of marked thickening of pluera or pulmonary fibrosis, delayed absorption should suggest the possibility of bronchial obstruction (e.g.mucus plug). Etilogies of a pneumothorax are numerous, frequently iatrogenic from the retroperitoneal area. Pneumomediastinum-can be caused by a surgical procedure in the retroperitoneal area with cephalad migration of air along contiguous fascial planes. Pneumomediastinum occurs frequently following diagnostic retroperitoneal air insufflation. It can also result from a pneumoperitoneum. Air may be introduced inadvertantly into the properitoneal tissue or it may enter this plane by seepage from the peritoneal cavity.The air in the properitoneal region courses upward deep to the abdominal muscles and between the diaghragm and the parietal peritoneum which covers its undersurface. From here, it may enter the mediastinum through one of the natural openings in the diaphragm.
ACR Code
6.4
Location
Endocrine (clinical)
Category
Radiologic Sign or Finding
Keywords
Pneumothorax
Pneumomediastinum
Reference
Schwartz,Emanuel E.;The Radiology of Complications in Medical Practice;1984,pp63,263 Rabin,Coleman B.,Baron,Murray G.,M.D.;Radiology of the Chest, Second Ed.;pp542-3,672-4
( This topic was added on 2006-11-14 and last edited on 2007-02-08 )
Image Author:
Original Source
Russell A. Patterson
Author
Russell A. Patterson
Author Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Pil Kang
Approver Affiliation
Uniformed Services University
Uniformed Services University

Case Author:
Case Affiliation
Uniformed Services University
Uniformed Services University
Author
Russell A. Patterson
Author Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Pil Kang
Approver Affiliation
Uniformed Services University
Uniformed Services University

Topic Author:
Topic Affiliation
Uniformed Services University
Uniformed Services University
Author
Russell A. Patterson
Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Les R Folio
Affiliation
Uniformed Services University
Uniformed Services University
Information about Affiliations is for information only and, does not imply endorsement nor approval by those institutions & organizations.