Correct!
5. All of the above

There is a right-sided pneumothorax consistent with previous chest x-ray findings and a component of right hydropneumothorax with a small to moderate sized right pleural effusion and an air interface (Figure 4, red arrows).  

Figure 4. Thoracic CT scan with some of the abnormalities indicated by arrows (see text for description).

There are extensive emphysematous changes throughout the lungs with multiple large bulla or bleb as above involving the bilateral lung apices and bilateral lung bases (Figure 4, white arrows). There is a small to moderate left-sided pleural effusion (figure 4, yellow arrows).

The patient had a chest tube placed for drainage of the pneumothorax.  An air leak was observed continuously for the next 3 weeks. A chest x-ray after 3 weeks is shown in Figure 5.

Figure 5. Chest radiograph taken after 3 weeks of continued drainage.

Which of the following are true?

1. An air leak is indicated by bubbling at the water seal in the pleural drainage system.
2. The pleural drainage system should be carefully checked for a source of an air leak.
3. The patient may have a bronchopleural fistula.
4. Thoracic surgery consultation should be obtained.
5. All of the above

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