EP 616 A Silent Pneumothorax Presenting as Abdominal Pain: A Diagnostic Pitfall in Primary Care
Leticia Gatti Fonseca, Barbara Gonçalves, Izabela Argentati, Bruna RamosAbstract
Aim
To report an atypical presentation of a severe thoracic condition diagnosed following a nonspecific abdominal complaint in a primary care setting, highlighting the surgical relevance of meticulous clinical examination and occupational history in the early recognition of potentially life-threatening pathology outside tertiary centres.
Methods
We report the case of a 57-year-old male, previously fit and well, employed in civil construction with prolonged occupational exposure to silica dust through underground excavation and pipeline installation. The patient presented to a primary care unit with a five-day history of postprandial abdominal discomfort and bloating. A full clinical assessment, laboratory investigations, and chest computed tomography were performed.
Results
Despite no initial respiratory complaint, the patient showed abnormal vital signs like desaturation and tachypnoea. Questions revealed mild exertional dyspnoea and dry cough. Thoracic exam revealed absent breath sounds and dullness over the right hemithorax. Chest CT showed a large right hydropneumothorax covering roughly 40% of the hemithorax, with lung atelectasis. Findings included bilateral micronodules, mild bronchial thickening, and right upper lobe consolidation with cavitation, plus a virtual pleural space on the left. Occupational history and imaging suggested pulmonary silicosis, with possible superimposed tuberculosis. The patient was referred to a tertiary centre for drainage and further workup.
Conclusion
This case illustrates a significant clinico-radiological discrepancy, where a benign abdominal presentation revealed a large spontaneous pneumothorax due to underlying occupational lung disease. It highlights the need for thorough physical examinations and occupational histories to identify serious conditions, even in minimally symptomatic patients.