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Tension pneumothorax

Case contributed by Dr Derek Smith

Presentation

Sudden onset pleuritic chest pain, with progressive dyspnea leading to presentation at hospital. Reduced air entry on right side, with hyper-resonance on examination. Reduced saturations on room air. Ex-smoker. No significant respiratory history.

Patient Data

Age: 45
Gender: Female
X-ray

There is a large right sided pneumothorax.

The trachea is central, however there is early mediastinal shift with rib splaying on the right.

No displaced rib fractures.

X-ray

Right sided intercostal drain in situ.

Re-expansion of the lung with normal lung volume.

Case Discussion

Spontaneous pneumothorax with early signs of tensioning.

This was quickly recognized by the clinical team who treated this with insertion of an intercostal chest drain. This is appropriately oriented to the apex of the lung.

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