Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax?
A. Dyspnea and reduced or absent breath sound over the right lung.
B. Tachycardia, hypotension, and cool, clammy skin.
C. Fever, rebound tenderness, and abdominal rigidity.
D. Redness, warmth, and drainage at the biopsy site.
Correct Answer: A. Dyspnea and reduced or absent breath sounds over the right lung
Signs and symptoms of pneumothorax include dyspnea and decreased or absent breath sounds over the affected lung (right lung). A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse.
Option B: The risk of fatal hemorrhage in patients without malignant disease is 0.04%, and the risk of nonfatal hemorrhage is 0.16%. In those with malignancy, the risk of nonfatal hemorrhage is 0.4% and 0.57% for nonfatal hemorrhage.
Option C: This can occur with the inadvertent puncture of the gallbladder or in patients with obstructive jaundice and dilated bile ducts. It usually presents with abdominal pain, fever, leukocytosis. It can also be painless in some patients. Biliary scintigraphy demonstrates the leak. Treatment is usually with fluids and antibiotics. Very rarely, endoscopic procedures like ERCP or surgery may be required.
Option D: This is usually clinically insignificant except in patients with obstructive jaundice like primary sclerosing cholangitis or in the post-transplant setting. Currently, there is no recommendation for treating with prophylactic antibiotics, and treatment can be offered on a case by case basis.
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