Tension haemothorax

Case contributed by Dr Henry Knipe

Presentation

Gunshot wound.

Patient Data

Age: 20 years
Gender: Male
Modality: X-ray

Almost complete white-out of the left hemithorax with small volume of subcutaneous emphysema. Tracheal and mediastinal shift to the right indicating a degree of tension. Metallic fragment just superiorly to the neck of the left 7th rib and a further linear opacity over the left 5th rib. Subcutaneous emphysema overlying the left scapula. 

20 minutes later

Modality: X-ray

On the follow-up chest x-ray 20 minutes later an ICC has been placed on the left with increased lucency of the left hemithorax. Trachea and cardiomediastinal contour has returned to midline. 

Case Discussion

On placement of the chest drain, 800 mL of fresh blood immediately drained. The patient was shocked, and was taken straight to theatre for exploration and haemorrhage control. 

Tension haemothoraces are uncommon but are life threatening causing both obstructive and haemorrhagic shock. 

This case also demonstrates the difficulty of trauma radiography with centring and collimation challenging in the setting of unstable patients requiring multiple urgent procedures at the same time as acquisition. 

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Case Information

rID: 47300
Case created: 11th Aug 2016
Last edited: 13th Oct 2016
Systems: Chest, Trauma
Inclusion in quiz mode: Included

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