Pseudo-pneumothorax: look before you leap!

Pseudo-Pneumothorax Due to Skin Folds in a Patient With Pneumonia

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.

A Case of Pseudo-pneumothorax with Complications

Pseudo-pneumothorax occurs after inappropriately diagnosing a pneumothorax based on a chest X-ray. This can be attributed to skin folds, bed sheets, previous pneumothorax, heating blankets, clothes, and other circumstances that may mimic the radiographic findings of a pneumothorax. We present a case where a patient underwent a tube thoracostomy due to the diagnosis of a pneumothorax that was not, in fact, present. The unnecessary intervention was complicated by hemoptysis and cardiac arrest.

Pseudopneumothorax in scoliosis surgery diagnosed with intraoperative O-arm computed tomography

Postoperative pneumothorax in posterior fusion using pedicle screws is uncommon, but the complication needs to be kept in mind. There are reports of a pseudopneumothorax resulting from artifacts. We report a unique case of a pseudopneumothorax in a patient with scoliosis, diagnosed using O-arm intraoperative computed tomography. The pseudopneumothorax, initially appearing on a chest radiograph, turned out to be an area of partial atelectasis at the lateral border of the right lower lobe. Spine surgeons and anesthesiologists must recheck images and maintain a high degree of suspicion for a pseudopneumothorax when the radiographic image during scoliosis surgery does not match the patient's condition.