Supine tension pneumothorax

Case contributed by Henry Knipe

Presentation

ICU admission with a large intracranial hemorrhage. Lines and tubes check.

Patient Data

Age: 40
Gender: Female
x-ray

Large right pneumothorax with mediastinal shift to the left indicating significant tension. ETT is in a satisfactory position. 

x-ray

Right pleural drain, with resolution of the pneumothorax and midline shift. Right subclavian CVC has been removed. 

Case Discussion

Subclavian CVCs can be complicated by pneumothoraces. On supine projections, the size and severity of pneumothoraces can easily be underestimated as most of the air lies anteriorly in the pleural space, and this is not well seen. 

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