Tension pneumothorax

Case contributed by Andrew Ho

Presentation

Acute decrease oxygen saturation and tachycardia in this intubated ICU patient.

Patient Data

Age: 20 years
Gender: Male
x-ray

Portable frontal radiography reveals a large right pneumothorax with marked shift of the mediastinum to the left as demonstrated by the leftward deviation of the endotracheal tube, trachea and cardiac silhouette.

Case Discussion

Tension pneumothorax is a medical emergency and defined as the presence of a pneumothorax AND hemodynamic compromise.

This intubated ICU patient developed spontaneous pneumothorax and was presumed to be iatrogenic due to high-pressure ventilation.  The left central venous catheter has been in place for several days without any complications and was not likely the cause of the pneumothorax.

A rough guideline for communicating the size of the pneumothorax to the clinician is based on the maximal pleural separation from the chest wall: small (< 2 cm) vs large (>2 cm) 1.

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