Picture Quiz: A crushed lung
A 72 year old woman was brought in from home with a Glasgow coma scale score of 14 out of 15 (eyes 4, verbal 4, and motor 6). Her family reported a six week history of increasing lethargy, general weakness, and confusion. She had had tuberculosis at the age of 20 and recalled some kind of surgery at this time. On examination she had no focal neurology. Her left lung base was dull to percussion, and she had decreased entry of air in the same area. Oxygen saturations were 60% on room air. She received 40% oxygen but deteriorated clinically. She had blood gases analysed (box) and a chest x ray done (figure).
The women has had a left phrenic nerve crush. Before the introduction of effective antituberculous chemotherapy in 1944 this was used as a treatment for tuberculosis. Since Mycobacterium tuberculosis thrives best in environments with high oxygen concentrations,