Volume 13
Number 2
Jun 2009
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Case Reports
S Houtman, RA Bouwman, JW Coumou, A Vonk Noordegraaf, RM Breukers

Case: A patient was presented after aspirating food. After drinking copious amounts of alcohol, she had fainted immediately after the first bite of her dinner. Bystanders started basic life support immediately. However, proper oxygenation remained very problem- atic until her presentation at our emergency department, where she was intubated and ventilated. She developed a left-sided tension pneumothorax immediately thereafter. Rib fractures, as a possible cause of a pneumothorax after cardiopulmonary resuscitation, were not apparent on the chest radiograph. After chest-tube insertion, oxygenation remained problematic. A chilli pepper was bronchoscopi- cally removed from the left main bronchus. Thereafter, her oxygenation improved.
Conclusion: Aspiration may present with sudden collapse without much coughing. Although rib fractures, sustained during cardiopulmonary resuscitation, may be the most frequent cause, other mechanisms may underlie a pneumothorax after accidental aspiration. We believe that in this case a chilli pepper caused a valve mechanism to develop, leading to hyperinflation and consequently a tension pneumothorax.

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