Tension pneumothorax


  • A 35 years old man
  • Involved in MVA
  • Complains of shortness of breath and chest pain
  • Examination shows no breath sound at left lung
  • Patient is also tachycardic, Blood pressure is normal
Chest radiograph PA erect view

Radiographic findings:

  • Collapsed left lung with visualization of left pleural lining (red arrows) with no lung parenchyma distal to this
  • Associated increased intercostal spaces on the same side
  • Tracheal shift to the right side (white arrow)
  • Depression of the left hemidiaphragm (yellow arrows)
  • Shift of mediastinum to the right side (block arrows)
  • No contusion in visualized aerated lung fields
  • No fracture of visualized bones

Diagnosis: Tension pneumothorax


  • Tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function.
  • Radiographic findings include the typical findings of pneumothorax with contralateral shift of mediastinum and trachea, ipsilateral depressed hemidiaphragm and increased intercostal spaces.
  • Treatment of a tension pneumothorax is one of the classic medical emergencies where life can be saved or lost on the basis of recognition and subsequent rapid decompression.
  • Numerous techniques exist, but in the first instance relieving the tension, even if not draining the pneumothorax, is life-saving.
  • A needle thoracostomy (e.g. 14G intravenous cannula) can be inserted, typically in the 2nd intercostal space in the midclavicular line, to gain valuable time, before a larger underwater drain chest tube can be inserted.


Author: radhianahassan