Tension pneumothorax in a ventilated patient

Case contributed by Frank Gaillard

Presentation

Increasing ventilatory pressures following attempted CVC insertion, after orthopaedia intervention on the lower limbs for multiple fractures as a result of an MVA.

Patient Data

Age: 50 years
Gender: Male

Supine Chest X-ray

x_ray

This film was obtained in the operating room recovery area. The patient is large and as a result the film is poorly penetrated in some areas. CXR demonstrates a tension pneumothorax, with shift of the mediastinum towards the left.

Case Discussion

A pneumothorax which would case only minimal problems in a 'normal' patient, can be life threatening when they are ventilated, as positive pressure ventilation forces more and more air into the pleural space. 

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