September 11, 2011

Tension Pneumothorax

Chest radiograph shows a very large left pneumothorax (stars) causing mass effect to the mediastinum (shifting, arrows), deep costophrenic sulcus and collapsed left lung.

Facts
  • One-way valve effect causing continuous air collection within pleural space resulting in collapse of the lung on the affected side and compression of opposite lung
  • Poor lung compliance and increased airway pressure leads to ineffective gas exchange
  • Mass effect on mediastinal structures cause decreased venous return and decreased cardiac output
  • Symptoms and signs: chest pain, dyspnea, respiratory distress, tachypnea, dyspnea, cyanosis, elevated jugular venous pressure, absent breath sounds, tracheal deviation and hemodynamic compromise
  • This is a clinical diagnosis and confirmation with radiography is not recommended. Needle decompression should be immediately performed
Imaging
  • Again, this is a clinical diagnosis. Yet imaging may be performed and shows large pneumothorax, mediastinal shifting, flat hemidiaphragm
Reference:
Greenberg MI. Greenberg's Text-atlas of Emergency Medicine, 2005.

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