Inhalation injury can be thermal and/or chemical. We report bilateral pneumothorax following acute inhalation injury.
A male worker in an upholstery factory was confined in the tanning machine for 15 min. The device was used to contain sodium sulfate, sulfur dioxide, and sulfuric acid. On admission, he was confused with Glasgow coma scale score as 9. His vital signs were as follows: blood pressure, 80/58 mmHg; pulse rate, 114 bpm; respiratory rate, 30 bpm; temperature, 37.1 degrees C; and oxygen saturation, 48%. He was intubated. Physical examination disclosed extensive subcutaneous emphysema on the neck and pinkish foamy discharge from the mouth. Chest X-ray showed bilateral pneumothoraces and pneumomediastinum that warranted bilateral tube thoracostomy. Bronchoscopy demonstrated web-shaped hyperemic areas on the upper airway mucosa with aphtous lesions in the base. Extensive hemorrhage and edema were evident around epiglottis. The patient was admitted to the intensive care unit and mechanically ventilated. He was discharged without any sequelae on day 8.
Exposure to irritant gases such as sulfuric acid and sulfur dioxide can cause severe pulmonary injury leading to pneumothorax and pneumomediastinum.