You should never take this chest x-ray

To take this chest x-ray is a common error for those without experience.

Tension-type pneumothorax

The diagnosis of Tension-type pneumothorax is a clinical one. That is because it’s a real emergency (inmediately life-threatening), that should be identified on primary survey.

Basis of Diagnosis:

  • Hyperresonance of affected hemithorax
  • Decreased or absence of breath sounds
  • Tracheal deviation to the other side of pneumothorax is
  • Respiratory distress
  • Hypotension
  • Tachypnea
  • Hypoxia
  • Distended neck veins (this could be absent if your patient is hypovolemic.

Mechanism: The air enters to the pleural space (a virtual one) and cannot escape, then the intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side.

Treatment: Needle decompression (thoracostomy) with large-bore needle in the second intercostal space in the midclavicular line to convert the tension pneumothorax into a simple pneumothorax. This simple procedure can save your patient’s life.

Be aware, explore your patient, establish a diagnosis and give a prompt and proper treatment.


Jon Mikel Iñarritu, M.D.

technorati tags: tension-type pneumothorax, tension pneumothorax, CXR, chest x-ray, x-ray, xray, pneumothorax, thoracostomy, unbounded medicine