Presentation
Acute shortness of breath and right sided chest pain.
Patient Data
Age: 30 years
Gender: Male
From the case:
Tension pneumothorax
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/86574/annotated_viewer_json?iframe=true\u0026lang=us"}
- with the patient centrally positioned, there are increased right lung field lucency, and no pulmonary markings peripheral to the medially displaced shadow of the lateral/peripheral margin of the hyperdense smaller (collapsed) right lung
- relatively wide ipsilateral/right intercostal spaces
- shifting of mediastinal shadows to the contralateral/left side
- no obvious or definite evidence of other lesions
From the case:
Tension pneumothorax
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/86578/annotated_viewer_json?iframe=true\u0026lang=us"}
A right-sided chest tube was inserted, followed by clinical improvement, and subsequent imaging revealed:
- right-sided chest tube shadow
- the right lung's bronchovascular markings appear filling almost all the right lung field, with remnant rim of lucency peripherally and superiorly
- no deviation of mediastinal shadow
- bilaterally, the intercostal spaces appear symmetrical
- multiple air-density foci in the right thoracic wall's soft tissue shadow around the site of chest tube insertion
Case Discussion
The initial radiograph shows features of a right-sided tension pneumothorax. In the absence of any underlying cause, it has to be considered as a primary spontaneous one.
The follow-up radiograph after insertion of a chest tube shows a successful right lung re-expansion with a small residuum and subcutaneous emphysema around chest tube insertion site.