Tension pneumothorax

Case contributed by Julian L. Wichmann
Diagnosis certain


Sudden left thoracic pain spreading to the left arm. Although pneumothorax was suspected, the patient was transferred for a complete triple-rule-out-CT.

Patient Data

Age: 30 years
Gender: Male

CT Scout + axial lung...


CT Scout + axial lung window images

A large left tension pneumothorax clear on the scout image. The left lung apex shows a small bulla as a potential cause for the tension pneumothorax. 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.

XR images after placement...


XR images after placement of Tx drain

Post-placement of chest tube shows a good inflation of the left lung with no residual pneumothorax. Extensive ipsilateral subcutaneous emphysema. 

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 chest radiating to 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 disease was also suspected by the radiologist and should be considered in the differential diagnoses for this case. Marfan disease is also a risk factor for pneumothorax.

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

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