Samuel A. Allen, DO

In the case described here, hypoxemic respiratory failure occurred secondary to a right-sided pleural effusion associated with an obstructive uropathy. The patient, a 75-year-old man with a history of benign prostatic hypertrophy (BPH), presented with a gradual onset of shortness of breath, tachypnea, and oliguria. Renal ultrasonography and CT scanning revealed bilateral hydronephrosis. A right thoracentesis yielded fluid with characteristics consistent with urinothorax. The patient was given medication for BPH, taught how to do self-straight catheterization, and scheduled for an outpatient cystoscopy. At follow-up, his chest radiograph showed no effusions.

We describe a rare case in which chest pain and subcutaneous emphysema developed while the patient was undergoing routine dental extractions under local anesthesia and inhaled nitrous oxide. The patient was found to have extensive pneumomediastinum on a CT scan of the chest. The patient received supportive care and 24-hour high-flow oxygen (100%) and was discharged the next day without any residual symptoms. At a 10-day follow-up visit, neck and chest radiographs revealed no further subcutaneous emphysema.