What else could the admitting team have done different?
Withdraw the tube, hyperventilate and repeat rapid chest x rays which these are digital and can be seen at the bedside and see if the left lung would have rexpanded without rushing into a chest tube. If still in doubt try a right lateral decubitus radiograph to exclude a left pneumothorax first before chest tube insertion.
How should a radiology resident on call approach this case?
1. Volume loss vs volume gain in which lung? Voume loss in left and volume gain in right lung. 2. If it was pneumothorax on the left then the mediastinal shift would have been to right. 3. Also pneumothorax is radioluscent and not radiodense as here.
The endotracheal tube is low. There is a left pleural pig tail catheter. There is unilateral left lung reexpansion pulmonary oedema.