A young A-A man was involved in a MVA and then brought at our hospital casualty.
A young community service doctor asked ChXR which discovered – right humerus #, multiple R upper ribs ## and right lung partial collaps (fig.1).
фото 1
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The casualty MO very quickly inserted an ICD on the right side – big air bubbling was registered via the underwater sealing drain. The happy MO ordered control ChXR … and he was very surprised to see no any improvement of the lung .. (fig. 2)
фото 2
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Three weeks later I saw the patient: on the control ChXR - without any improvement + air-fluid levels… In the ICD – the obvious purulent fluid was swinging.. . On CT of the chest – the same information + stenosis of the right main bronchus which I considered as the result of the lung collaps.

Next day I did right thoracotomy and with great proud removed multiple septated purulent cavities and without any technical difficulties performed the lung decortication with only one tear of the lung…

- Inflate the lung, please – I asked the anestesist.
And – shit happened - the lung did not want to expand…

I closed the chest wall and tried to diminish the pleural pressure using our OR vacuum suction – no effect (fig. 3)
фото 3
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Even worst – BP dropped down and arrhythmia was noted
(BTW - the question for young doctors – why??)

- Scope!!!!!!!!”
Bronhoscopy on the table !!!!
фото 4
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Please, your comments, thoughts about the diagnosis and suggestions – what next???..