Tension pneumothorax

Case contributed by Dr Balint Botz

Presentation

Sepsis, pneumonia, reduced blood oxygenation and respiratory sounds upon auscultation on the right after urgent bronchoscopy.

Patient Data

Age: 65
Gender: Male
X-ray

AP, supine CXR - ICU

The right lung is largely collapsed as a consequence of a large basal pneumothorax, with the exception of the upper lobe. 

Three alarming features are present:

1. The mediastinum has markedly shifted to the left.

2. The right hemidiaphragm is depressed. 

3. The right lower intercostal spaces have widened. 

The diagnosis of a tension pneumothorax was immediately communicated, and a chest tube was subsequently inserted. 

X-ray

Control CXR approximately 60 minutes later

The control x-ray demonstrates the complete regression of the right sided pneumothorax and the signs of a tension mechanism. The chest tube is in an appropriate position, with a small amount of subcutaneous emphysema that developed in the soft tissues adjacent to its insertion point. Bilateral patchy airspace opacities and the blunting of the costophrenic angles can also observed, due to the known pneumonia and a moderate bilateral hydrothorax. 

Case Discussion

The case demonstrates key imaging features of tension pneumothorax, and the rapid improvement after management. 

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Case information

rID: 62557
Published: 22nd Aug 2018
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included
Institution: University of Pécs

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