A #RadiologyRounds case with 3 different imaging modalities! A 65+ year old man never smoker, former marathoner has had 2-3 years of progressive non-productive, incessant cough with decreasing exercise tolerance. Some select CT scan slices are below
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/CT-Images-383x1024.jpg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/Screenshot-2024-03-12-at-10.11.29 PM-1024x495.png)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/Screenshot-2024-03-12-at-10.11.36 PM-1024x478.png)
You are considering multiple etiologies including airway bleeding, pneumothorax, and hemothorax. You grab an ultrasound and perform a lung / pleural POCUS. Here is what you see
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/ezgif.com-animated-gif-maker.gif)
The long POCUS shows an area of lung sliding and an area without any lung sliding. This is called lung point and is diagnostic of a pneumothorax. To get a better look at this, you can use M-mode.
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/Screenshot-2024-03-12-at-9.32.01 PM-1024x598.png)
A CXR confirmed the finding of a pneumo. He was trialed on 100% oxygen but repeat CXR showed the pneumothorax was expanding. He had a chest tube placed with re-expansion of his lung and no air leak. It was able to be removed the next morning without incident
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/1-1024x832.jpg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/Pneumo-1024x276.jpg)
Here is our algorithm for pneumothorax!
![](https://www.pulmpeeps.com/wp-content/uploads/2024/03/Pneumothorax-Graphic-small-580x1024.jpg)
Both BAL and tbbx returned positive for MAI complex. He was HIV neagative. Given his persistent and bothersome symptoms, he was started on treatment for pulmonary MAC with a macrolide, ethambutol and a rifamycin with plan for 6 months of therapy. He improved with this