Pneumothorax is quite unusual to occur during or following cesarean section, as only six cases have been reported so far, and only one of them was bilateral. Here, we report a 19-year-old, previously healthy, non-smoking primigravida who underwent a cesarean section under general anesthesia, and whose oxygen saturation level quickly dropped to 81% following endotracheal intubation. Although an initial chest radiograph did not demonstrate pneumothorax, a CT scan performed on the following day showed the patient had developed bilateral pneumothorax. Chest tubes were inserted on both sides, and the patient was discharged on the sixth postoperative day in stable condition. This case underlines the need to include pneumothorax in the differential diagnosis when managing a patient with acute respiratory distress during cesarean section or in the immediate post-operative period.
Pseudo-pneumothorax refers to several conditions that can mimic pneumothorax on chest radiography, leading to diagnostic uncertainty and unnecessary interventions. These include skin folds, bed sheet folds, clothes, scapular borders, pleural cysts, and elevated hemidiaphragm. We report a case of a 64-year-old patient with pneumonia whose chest radiograph revealed, in addition to the typical pneumonia findings, what appeared similar to bilateral pleural lines raising the suspicion of bilateral pneumothorax, but this finding was not supported clinically. Careful reexamination and further imaging ruled out the possibility of pneumothorax and concluded that this was the result of artifacts produced by skin folds. The patient was admitted and received intravenous antibiotics and was discharged three days later in stable condition. Our case highlights the importance of careful examination of imaging findings before unnecessarily proceeding to tube thoracostomy, especially when the clinical suspicion of pneumothorax is low.
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