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Hole In The Wall BTS


Photography Tips For The Hole In The Wall At Rialto Beach: Bring a wide lens. For this trip, we used a Canon 16-35mm f/2.8 Mark II lens. Depending on your positioning on shore, you can make the hole look giant, or extremely small! Play with perspective and find out which one you like best.




Hole in the Wall BTS



The one where Hoseok moves into the apartment next door to Jungkook.On top of the thin walls and a sexually active neighbor, Hoseok comes across a hole in his wall which coincidentally opens into Jungkook's bedroom.


Subcutaneous emphysema can also arise from migration of the side port of the ICD into the chest wall [3] (suggesting inadequate anchorage) and was responsible for a fifth of cases of SCE in the aforementioned series [3]. Side port migration has been a commonly reported cause in other series [8].


a & b. Axial and coronal slices of a computed tomography scan of thorax demonstrating severe subcutaneous emphysema. This study was from a patient treated at our medical centre who had pneumothorax and pneumo-mediastinum in the context of metastatic renal cell carcinoma. The arrow denotes metastatic erosion through the chest wall leading to pneumothorax.


In their seven year retrospective cohort study, Cerfolio et al evaluated 255 patients with SCE following elective surgery for pulmonary resection. All of these patients were treated with a 28F intercostal drain to which -40 cmH20 of suction was applied. Some of these patients also had a second intercostal drain sited. Of the latter group, the majority 170 (67%) experienced resolution of their subcutaneous emphysema. It is difficult to know if these results are generalizable to SCE in spontaneous pneumothorax or other causes of pneumothorax, particularly as the SCE experienced by this group was frequently noted to be due to air leaking into the subcutaneous tissues directly from lung that had adhered to the chest wall post-operatively [21].


Another option is to place fenestrated angio-catheters into the deep and oblique fascial layers of the chest wall. In 2002 Beck et al described the use a fenestrated 14G venflon placed into the subcutaneous tissue of a patient with SCE under local anaesthetic, 2-3cm lateral to the midclavicular line. The fenestrations were made to the catheter over its steel stylette using a scalpel in a spiral pattern (to increase rigidity). The angio-catheter was inserted subcutaneously medially at a 45 angle so the tip ended approximately 1 to 1.5cm deep to the skin before being secured. Multiple variations of this technique have been described regarding, the number of angio-catheters used, positioning of the catheters, and the depth and angle of placement within the subcutaneous tissues [27, 37]. The technique has also incorporated attaching the catheter to an underwater seal as well as compressive massage to enhance drainage [6, 38].


Pneumothorax depicted on illustration (a) and frontal chest radiograph (b). The visceral pleural line (marked by black arrows on b) is displaced medially and a lucency (air) intervenes between the chest wall and the outer surface of the right lung. Right lung is partially collapsed. * indicates the deep sulcus sign


* At least 1 mL of Omnipaque 350 per 37.4 cc of water [60]. A more concentrated 10 % solution is better to delineate these defects [19]. If patient is able to swallow, they are instructed to hold their breath and swallow; otherwise, they are asked to sip continuously from a cup with a straw. In unconscious patients, contrast may be injected thorough a nasogastric (NG) tube


A focal kink in the extra- or intrathoracic portion of the chest tube will obstruct the lumen and lead to suboptimal evacuation of the pneumothorax (Fig. 5). Incomplete insertion of the chest tube with its side hole outside the pleural cavity can lead to suboptimal evacuation of air (Fig. 6). If the side hole (sentinel eye) is outside the chest wall, it may lead to backflow of atmospheric air into the pleural space. Intrafissural position of the chest tube may or may not have clinical consequences [25, 26]. It can lead to delayed or poor evacuation of the pleural effusion or pneumothorax [27].


An 88-year-old male with underlying COPD and bullous emphysema presented with a spontaneous left pneumothorax. Despite subsequent chest tube and anterior pleural catheter placement, left pneumothorax persisted. Upon careful review of the radiograph, side hole of the left chest tube was outside the pleural cavity (black arrow) and communicated with the atmospheric air


A 69-year-old male struck by a motor vehicle. CT was obtained to assess etiology of a non-resolving pneumothorax. Axial (a) and coronal (b) CT images through the chest demonstrate intra parenchymal placement of chest tube within the right upper lobe. Ground glass opacity (arrow) surrounding the chest drain represents lung laceration. Incidentally noted right pleural fluid and right anterior chest wall soft tissue emphysema


A tube inserted too far can lead to mediastinal placement (Fig. 8). Complications of mediastinal tube placement include perforation of oesophagus, pulmonary artery and heart. Muscular chest wall, obesity or presence of chest wall emphysema can lead to the tube being placed in the chest wall outside the pleural cavity. When the tube is placed across the lateral chest wall, it can be recognized on radiographs; however, for anteriorly or posteriorly placed tubes or drains, such as for loculated pneumothorax (Fig. 9), CT is more useful.


A 67-year-old male with multiple rib fractures status post fall. Chest radiograph (a) demonstrates a pleural pigtail drain projecting over the lower left chest (circle). Axial CT image through the upper thorax (b) demonstrates anterior mediastinal location of the drain (circle) with extensive pneumomediastinum and chest wall emphysema


A 52-year-old female status post motor vehicle accident had an emergent chest tube placement by EMR. Semi-erect AP radiograph (a) demonstrates chest tube projecting over the left lateral upper-mid chest; positioning was thought appropriate. However, subsequently performed CT (b) demonstrates chest tube tip within the soft tissues of the posterior chest wall (black arrow), between the outer surface of the rib and scapula. Tube was outside the pleural cavity


A 54-year- old-male status post aortic aneurysm repair presented with a persistent left pneumothorax. On axial (a) and coronal (b) CT images, air surrounds the portion of the chest tube coursing through the chest wall (arrows). This indicates an incomplete seal. If the site of thoracotomy is not optimally occluded with surgical dressing, or if the incision is too large relative to the tube, an air leak may develop. This leak allows air back into the pleural space during inspiration and results in a nonresolving pneumothorax


An 83-year-old smoker with chest pain and recurrent pneumothorax. Frontal chest radiograph on admission (a) demonstrates a large right pneumothorax (pleural interface marked by white arrows). Axial chest CT minimum intensity projection (minIP) image (b) demonstrates discontinuity of the walls of a bulla (solid black arrow) compatible with a ruptured bulla


A 28-year-old patient with lymphangioleiomyomatosis, recurrent pneumothoraces and chest pain. Chest CT axial image (a) demonstrates multiple cysts in both lungs. Thin slice image (b) with a sharpened reconstruction kernel clearly demonstrates the discontinuity of the walls of a cyst (arrow) compatible with an alveolopleural fistula


With ballistic injury, direct tissue laceration along the trajectory of the bullet forms a permanent cavity, followed by a temporary cavity due to pressure gradients radial to the trajectory of the bullet [48]. The temporary cavity depends on the velocity and size of the bullet [49]. The penetrating projectile disrupts the chest wall, parietal pleura, visceral pleura, and alveolar wall. This results in a direct communication of the atmospheric air with the pleural space or/and alveolus with the pleura space.


A 40-year-old male presented to the ED with multiple rib fractures sustained after a fall from height. Mediastinal window image from axial chest CT (a) demonstrated a markedly displaced right-sided posterior rib fracture. The same image on lung window (b) demonstrated a small right pneumothorax secondary to bronchopleural fistula secondary to traumatic lung laceration. Right posterior chest wall soft tissue emphysema was seen on both (a) and (b). VR image (c) demonstrates the displaced rib fractures


A 32-year-old female presented with a stab wound to the left anterolateral chest. Lung window axial CT image through the mid-chest demonstrated an irregular, gas-filled defect along the left anterior chest wall extending to the pleural cavity (arrow). This allowed for direct communication of the pleural space with atmospheric air. Associated large left and moderate right pneumothoraces were present. Pneumothorax is likely to persist in this scenario of an open wound communicating with the atmosphere


A 47-year-old male, post gastric pull through for oesophageal cancer. Axial CT (a) image through the mid-chest demonstrates direct communication of the right main stem bronchus with the stomach (S) (black arrow) resulting in a broncho-gastric fistula. Several slices inferiorly (b), posterior gastric wall is dehiscent (circle) and communicates with the pleural space (P), resulting in a gastropleural fistula. Note the chest tube within the posterior right pleural space


In their individual pictures, the members stood in front of a round wall, resembling a door, that had holes made by bullets. Sharing the pictures, Big Hit captioned them, "#BTS #BTS_Proof Concept Photo (Proof ver.)." 041b061a72


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