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Case 41

Cervical sympathectomy with post operative pneumothorax

Post operative chest pain

This film was taken in the post operative period. The patient, a young man, was complaining of some right sided pleuritic chest pain. What does the film show, what surgery has been performed, and why?

An enlarged portion of the previous film is presented for clarity. What is shown?

Findings

Surgical clips are evident at the right apex after a recent cervical sympathectomy. A line of metal skin closures are also visible. A moderate sized pneumothorax is just visible; more so on the enlarged image.

Diagnosis

Cervical sympathectomy with post operative pneumothorax

Discussion

The reason for the cervical sympathectomy in this gentleman was persistent pain from the right arm despite a previous amputation (not visible). The amputation was for a large congenital venous malformation of the arm. Note the calcified phleboliths visible within the malformation over the right shoulder.

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