Tension pneumothorax

Case contributed by Dr Julian L. Wichmann

Presentation

30 yo male with sudden onset of left thoracic pain spreading out to the left arm. Although pneumothorax was suspected, patient was transferred for a complete Triple-Rule-Out-CT.

Patient Data

Age: 30
Gender: Male
CT

CT Scout + axial lung window images

An extensive tension pneumothorax on the left can already be demarcated on the scout image. The heart is displaced to the right. The planned triple-rule-out protocol was aborted, an unenhanced scan of the thorax was performed and the patient was immediately transferred to the emergency department for tube thoracostomy.

X-ray

X-ray images after placement of thoracic drain

X-ray images after placement of chest tube show a good ventilation of the left lung and no residual tension pneumothorax.

Case Discussion

This case of a sudden onset of a tension pneumothorax in an otherwise healthy young male demonstrates the necessity to look for the obvious pathology. Although the patient complained about pain in the left hemithorax spreading out into the left arm, acute myocardial infarction is less likely than a pneumothorax, especially in this young patient with no history of heart disease.

As the patient was > 2.0 m in height, aortic dissection due to undetected Marfan's diease was also suspected by the radiologist and should be in your differential diagnoses for this case.

As the patient's vital signs were stable, patient was immediately transferred to the emergency department for tube thoracostomy rather than performing an emergency needle thoracostomy.

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Case information

rID: 25861
Case created: 12th Nov 2013
Last edited: 6th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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