Presentation
Gunshot wound.
Patient Data
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.
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 theater for exploration and hemorrhage control.
Tension hemothoraces are uncommon but are life threatening causing both obstructive and hemorrhagic shock.
This case also demonstrates the difficulty of trauma radiography with centering and collimation challenging in the setting of unstable patients requiring multiple urgent procedures at the same time as acquisition.