Broaddus VC, Mason RJ, Ernst JD, et al, eds. 4. The most common underlying abnormality in secondary spontaneous pneumothorax is chronic obstructive pulmonary disease (COPD), and cystic fibrosis carries one of the highest associations, with more than 20% reporting spontaneous pneumothorax. During video-assisted thoracic surgery (VATS), pneumothorax is treated with pleurodesis. Abdominal distention may occur from increased pressure in the thoracic cavity producing caudal deviation of the diaphragm and from secondary pneumoperitoneum produced as air dissects across the diaphragm through the pores of Kohn. Connective Tissue Disease-Interstitial Lung Disease, Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs. An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. Is routine tube thoracostomy necessary after prehospital needle decompression for tension pneumothorax? 2004 Mar. Patients with trauma tend to have an associated pneumothorax or tension pneumothorax 20% of the time. http://creativecommons.org/licenses/by-nc-nd/4.0/. Depending on the depth of a penetrating chest wound, the air will flow into the pleural space either through the chest wall or from the visceral pleura of the tracheobronchial tree. Harcke HT, Pearse LA, Levy AD, Getz JM, Robinson SR. Shields TW. 2004 Jun. 2006 Jul 1. Eckstein M, Suyehara D. Needle thoracostomy in the prehospital setting. That pressure gradient between the lung and pleural space prevents the lung from collapsing. Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit. Leslie MD, Napier M, Glaser MG. Pneumothorax as a complication of tumour response to chemotherapy. Roberts DJ, Leigh-Smith S, Faris PD, Blackmore C, Ball CG, Robertson HL, Dixon E, James MT, Kirkpatrick AW, Kortbeek JB, Stelfox HT. Chest. The timely and accurate evaluation leadsto early interventions decreasing mortality and morbidity. 5 (3):181-2. Only 1.25% of the air is absorbed without oxygen in 24 hours. Rodriguez RM, Hendey GW, Marek G, Dery RA, Bjoring A. Nevertheless, tension pneumothorax should always be a consideration when acute compromise occurs. 2004 May. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. CXR can demonstrate one or more of the following: A chest computed tomography can be done if the diagnosis is unclear on the X-ray. [QxMD MEDLINE Link]. Wax DB, Leibowitz AB. Zehtabchi S, Rios CL. Symptoms and Signs of Thoracic Trauma. [QxMD MEDLINE Link]. 2000 Mar 23. [Guideline] MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group. C.A.U.S.E. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. The diagnosis may become evident only if the patient is receiving positive-pressure ventilation. [3], On examination, it is essential to assess for signs of respiratory distress, including increased respiratory rate, dyspnea, and retractions. However, the risk of lung re-expanding quickly increases the risk of pulmonary edema. [QxMD MEDLINE Link]. Am Surg. [31][32][33][34], Patients requiring surgical intervention are usually patients with bilateral pneumothoraces, recurrent ipsilateral pneumothoraces, first presentation in patients with high-risk professions like pilots and drivers, and patients with persistent air leaks (for more than seven days). Tension pneumothorax with pneumopericardium. Ann Thorac Surg. 2004 Oct 30. 2004 Jun. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis. 56 (3):527-30. [QxMD MEDLINE Link]. Eventually, impaired venous return results in cardiac arrest and . [QxMD MEDLINE Link]. Moreover, central venous catheter insertion was responsible for 13.2%of cases. Hypotension that worsens with inspiration Hypotension that worsens with inspiration is associated with tension pneumothorax due to compression of the heart and great vessels (obstructive shock). [QxMD MEDLINE Link]. This creates a diffusion gradient for nitrogen, thus accelerating the resolution of the pneumothorax. J Med Genet. Blunt thoracic trauma patiens may have tracheal deviation and deformities of the chest wall may be observed. Mutations of the Birt Hogg Dube gene in patients with multiple lung cysts and recurrent pneumothorax. Causes of traumatic pneumothorax include the following: Iatrogenic (induced by a medical procedure). Administration of 100% supplemental oxygen can help reduce the size of the pneumothorax bydecreasing the alveolar nitrogen partial pressure. Differential diagnoses of tension pneumothorax include: Tension pneumothorax must be treated immediately to avoid further associated morbidity and mortality. Paydar S, Ghahramani Z, Ghoddusi Johari H, Khezri S, Ziaeian B, Ghayyoumi MA, Fallahi MJ, Niakan MH, Sabetian G, Abbasi HR, Bolandparvaz S. Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) [QxMD MEDLINE Link]. Unlike the obvious patient presentations oftentimes used in medical training courses to describe a tension pneumothorax, actual case reports include descriptions of the diagnosis of the condition being missed or delayed because of subtle presentations that do not always present with the classically described clinical findings of this condition or the complexity of the patient with critical illness or injury. Familial spontaneous pneumothorax. Expiratory radiograph of a patient with a small spontaneous primary pneumothorax (same patient as in the previous images). encoded search term (Pneumothorax) and Pneumothorax, Sudden-Onset Chest Pain in an 80-Year-Old Man With COPD. J Thorac Cardiovasc Surg. Computed tomography scan demonstrating emphysematouslike changes (ELCs) in a patient with chronic obstructive pulmonary disease (COPD). [QxMD MEDLINE Link]. Vallee P, Sullivan M, Richardson H, Bivins B, Tomlanovich M. Sequential treatment of a simple pneumothorax. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Peuker E. Case report of tension pneumothorax related to acupuncture. If patients who are mechanically ventilated are difficult to ventilate during resuscitation, high peak airway pressures are clues to pneumothorax. McPherson JJ, Feigin DS, Bellamy RF. [QxMD MEDLINE Link]. Charles W. Lanks, Vanessa Correa. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. At the time the article was last revised Ian Bickle had no recorded disclosures. 2006 Jul. Presentation is variable and may initially have no symptoms. Tension pneumothorax has been reported during surgery with both single- and double-lumen tubes. [QxMD MEDLINE Link]. Patients with pneumothorax can be either asymptomatic or symptomatic. (2004) ISBN:0781736552. 21 (3):393-4. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. El-Nawawy AA, Al-Halawany AS, Antonios MA, Newegy RG. When a patient is hemodynamically stable, radiographic evaluation is recommended. (2011) The Korean journal of thoracic and cardiovascular surgery. A non-tension pneumothorax is properly called a simple pneumothorax. 2004 Mar. Computed tomography scan demonstrating blebs in a patient with chronic obstructive pulmonary disease (COPD). Chest. Iannoli ED, Litman RS. [QxMD MEDLINE Link]. 31 (2): 242-4. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Causes of tension pneumothorax Trauma to the chest, including a punctured lung, is the usual cause of a tension pneumothorax. As the pressure increases, it will cause the mediastinum to shift towards the contralateral side, contributing further to hypoxemia. Light RW, Lee YCG. Causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax. Radiograph demonstrating tension and traumatic pneumothorax. 2006 Jan. 72 (1):31-4. Shoaib Alam, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, International Society for Magnetic Resonance in Medicine, European Respiratory Society, Pennsylvania Thoracic SocietyDisclosure: Nothing to disclose. Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. Pneumothoraces are classified as simple (no shift of mediastinal structures), tension (shift in mediastinal structures present), or open (air passing through an open chest wound). Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. [QxMD MEDLINE Link]. The first-line responders when a patient develops a traumatic or tension pneumothorax vary depending on the situation and underlying etiology. Knowledge of necessary emergency thoracic decompression procedures is essential for all healthcare professionals. 4 (4):235-8. Curr Opin Pulm Med. ( 2006 May. With blunt force trauma, a pneumothorax can occur if a rib fracture or dislocation lacerates the visceral pleura. Symptoms of tension pneumothorax may include chest pain (90%), dyspnea (80%), anxiety, fatigue, or acute epigastric pain (a rare finding). J Trauma. Soldati G, Iacconi P. The validity of the use of ultrasonography in the diagnosis of spontaneous and traumatic pneumothorax. [Full Text]. In stable patients, local anesthesia or adequate analgesia/sedation should be administered. With mechanical pleurodesis, there is a less than 5% chance of recurrence of pneumothorax. However, tension pneumothorax is typically symptomatic, and its features are more impressive than spontaneous pneumothorax. Hsu CW, Sun SF, Lee DL, Chu KA, Lin HS. In addition to the sonographic features of pneumothorax, a RUSH exam (often performed in the setting of hemodynamic instability) the following features imply the presence of tension physiology 8: 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. 2002 Mar. Upon history taking, it is essential to note whether the patient previously had a pneumothorax, asrecurrence is seen in more than 15% of cases on either the ipsilateral or contralateral side. Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Women aged 30-40 years who present with onset of symptoms within 48 hours of menstruation, right-sided pneumothorax, and recurrence raise suspicion for catamenial pneumothorax. This chest radiograph shows pneumomediastinum (radiolucency noted around the left heart border) in this patient who had a respiratory and circulatory arrest in the emergency department after experiencing multiple episodes of vomiting and a rigid abdomen. On examination, breath sounds are absent on the affected hemothorax and the trachea deviates away from the affected side. Brook OR, Beck-Razi N, Abadi S, Filatov J, Ilivitzki A, Litmanovich D, et al. Acad Emerg Med. [QxMD MEDLINE Link]. StatPearls Publishing, Treasure Island (FL). Knudtson JL, Dort JM, Helmer SD, Smith RS. Review the management options available for tension pneumothorax. 7. Check the full list of possible causes and conditions now! Bedside sonography for detection of postprocedure pneumothorax. In one series, acute onset of chest pain and shortness of breath were present in all patients in one series; typically, both symptoms are present in 64-85% of patients. 2013 Jun. The first rib is often fractured posteriorly (black arrows). 2012 Mar. It is the most reliable imaging study for diagnosing pneumothorax, but it is not recommended for routine use. Computed tomography scan demonstrating a bulla in an asymptomatic patient. Initial assessment to determine whether the patient is stable or unstable dictates further evaluation. Radiograph of a patient with idiopathic pulmonary fibrosis and a small pneumothorax, following video-assisted thoracoscopic surgery (VATS) lung biopsy. Please confirm that you would like to log out of Medscape. Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events related to acupuncture. Although tension pneumothorax may be a difficult diagnosis to make and may present with considerable variability in signs, respiratory distress and chest pain are generally accepted as being universally present, and tachycardia and ipsilateral air entry on auscultation are also common findings. Intensive Care Med. Central venous catheterization in the subclavian or internal jugular vein, Barotrauma due to positive pressure ventilation, Conversion of spontaneous pneumothorax to tension, A thin line representing the edge of the visceral pleura, Effacement of lung markingsdistally to this line, The mediastinal shift away from the pneumothorax in tension pneumothorax, Tracheal deviation to the contralateral side of tension pneumothorax, Flattening of the hemidiaphragm on the ipsilateral side (tension pneumothorax), Damage to the neurovascular bundle during tube thoracostomy, Pain and skin infection at the site of tube thoracotomy. Imaging Chest x-ray [6] [8] Indications: all patients suspected of having pneumothorax Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Occasionally, it can have a subtle presentation too. If you log out, you will be required to enter your username and password the next time you visit. Barton ED, Rhee P, Hutton KC, Rosen P. The pathophysiology of tension pneumothorax in ventilated swine. Tracheal deviation is an inconsistent finding. Management strategies depend on the hemodynamic stability of the patient. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-15362, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":15362,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/tension-pneumothorax/questions/870?lang=us"}, View Frank Gaillard's current disclosures, see full revision history and disclosures, dilation (>2.1 cm) and absence of variation with respiration imply a pathologically elevated CVP, consistent with obstructive, hyperdynamic right heart with underfilling, the right ventricular diameter will be reduced as a result of the reduction in filling/preload. BMJ. 5. In PSP, chest often improves over the first 24 hours, even without resolution of the underlying air accumulation. (2018) Journal of Ultrasound in Medicine. Tension pneumothorax occurs when the air enters the pleural space but cannot fully exit, similar to a one-way valve mechanism through the disrupted pleura or tracheobronchial tree. Respiration. On pressure control ventilation, tension pneumothorax causes sudden drop in tidal volume. Symptomatic patients will present with sharp pleuritic pain that can radiate to the ipsilateral back or shoulder. [37][38], Ventilator-related tension pneumothorax has been found to have dire outcomes and result in death more frequently. Methods by which these mechanisms may maintain arterial blood pressure during tension pneumothorax include: 1) incomplete transmission of ipsilateral pneumothorax-related pressure to the mediastinum and contralateral hemithorax; 2) maintenance of cardiac venous return through rising spontaneous respiratory effort resulting in increasingly [Full Text]. Note that the hole on a chest tube is outside the pleural space. With time severe dyspnea, tachycardia and hypotension occur. Henry M, Arnold T, Harvey J., Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. Jalota Sahota R, Sayad E. Tension Pneumothorax. [Full Text]. Lal A, Anderson G, Cowen M, Lindow S, Arnold AG. Chest. If a patient is hemodynamically unstable with a high clinical suspicion of pneumothorax, needle decompression, or tube thoracostomy must be done immediately. [QxMD MEDLINE Link]. Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study. Bense L, Lewander R, Eklund G, Hedenstierna G, Wiman LG. For a general discussion, refer to the pneumothoraxarticle. The initial assessment involves a chest radiograph (CXR) to confirm the diagnosis.[21]. This rise in pressure further compresses the lung and decreases its volume. Greenberg MI. In these situations, care coordination is vital, and having different team members trained and ready to act promptly is life-saving. Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest. Tension pneumothorax. These trauma patients may have multiple tissue contusions and laserations. 70 (5):1019-23; discussion 1023-5. By definition, spontaneous pneumothorax is not associated with trauma or stress. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Bickle I, Sharma R, et al. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Pleural cavity (or intrapleural) pressure is negative as compared to lung pressure and atmospheric pressure. 47 (5):415-8. Positive pressure ventilation should be avoided initially, as it will increase the tension pneumothorax's size. 2006 Mar. . 2003 Jun. 129 (3):545-50. Chest. Toffel M, Pin M, Ludwig C. [Thoracic Surgical Aspects of Seriously Injured Patients]. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation. 329 (7473):1008. This will cause the lung to collapse on the ipsilateral side. Hypoxemia also triggers pulmonary vasoconstriction and increases pulmonary vascular resistance. Prevalence of tension pneumothorax in fatally wounded combat casualties. Philadelphia: Elsevier Saunders; 2016. A tension pneumothorax will have the same features as a simple pneumothorax with a number of additional features, helpful in identifying tension. Ultrasound findings includethe absence of lung sliding and the presence of a lung point. J Trauma. Busch M. Portable ultrasound in pre-hospital emergencies: a feasibility study. 98 (7):579-90. Computed tomography scan in a patient with a history of bilateral pleurodesis and a strong family history of spontaneous pneumothorax. 3. 22 (1):40-3. Symptoms of spontaneous pneumothorax might appear when a person is at rest. [QxMD MEDLINE Link]. General Thoracic Surgery. 2004 Feb. 11 (2):211-3. A non-tension pneumothorax is properly called a simple pneumothorax. Distended neck veins and tracheal deviation are also often present. Michael G Benninghoff, DO, MS Attending Physician in Pulmonary and Critical Care Medicine, Christiana Medical Center Thorac Cardiovasc Surg. In the case of trauma, this usually happens outside the hospital or in the emergency department (ED). 2011 May. If the patient is stable, then diagnostic imaging (i.e., CXR) can be done prior to treatment. [QxMD MEDLINE Link]. 2. BTS guidelines for the management of spontaneous pneumothorax. 35 (2):144-5. 13 (3):209-10. 1995 Sep. 13 (5):532-5. Note the right-sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right-sided bronchial tree. How emergency physicians choose chest tube size for traumatic pneumothorax or hemothorax: a comparison between 28Fr and smaller tube. 2001 Apr. In cases of tension pneumothorax, immediate decompression is a priority and should not be delayed by imaging. Slater A, Goodwin M, Anderson KE, Gleeson FV. Lee CC, Lee SH, Chang IJ, Lu TC, Yuan A, Chang TA, et al. 2001 Feb. 119 (2):590-602. [QxMD MEDLINE Link]. 28 (1): 29-56, vii. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, et al. Access free multiple choice questions on this topic. Rojas R, Wasserberger J, Balasubramaniam S. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. Assessment of pneumothorax resolution is usually done with serial chest X-rays. [QxMD MEDLINE Link]. In a supine patient, the examiner should lower themselves to be on a level with the patient. Findings may be affected by the volume status of the patient. Chemical pleurodesis in primary spontaneous pneumothorax. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax. Delius RE, Obeid FN, Horst HM, Sorensen VJ, Fath JJ, Bivins BA. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. Sonographic detection of pneumothorax by radiology residents as part of extended focused assessment with sonography for trauma. On examination, breath sounds are absent on the affected hemothorax and the trachea deviates away from the. Almoosa KF, Ryu JH, Mendez J, Huggins JT, Young LR, Sullivan EJ, et al. ADVERTISEMENT: Supporters see fewer/no ads. Tension pneumothorax is an uncommon condition with a malignant course that might result in death if left untreated. 10 (4):R112. [Full Text]. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Although historic emphasis has been placed on tracheal deviation in the setting of tension pneumothorax, tracheal deviation is a relatively late finding caused by midline shift. All the above causes can further cause tension pneumothorax as well as: Traumatic and tension pneumothoraces are more common than spontaneous pneumothoraces. Sedrakyan A, van der Meulen J, Lewsey J, Treasure T. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. New options for pneumothorax management. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Worsening pneumothorax Positive-pressure ventilation can lead to increased air in the chest cavity without a route of escape, worsening a pneumothorax and possibly leading to a tension pneumothorax. Clinical characteristics, hospital outcome and prognostic factors of patients with ventilator-related pneumothorax. Decreased movement of the affected hemithorax. Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy?. 37 (3):180-2. de Lassence A, Timsit JF, Tafflet M, Azoulay E, Jamali S, Vincent F, et al. Knowledge of necessary emergency thoracic decompression procedures is essential for all healthcare professionals. Lopes JA, Frankel HL, Bokhari SJ, Bank M, Tandon M, Rabinovici R. The trauma bay chest radiograph in stable blunt-trauma patients: do we really need it?. ), which permits others to distribute the work, provided that the article is not altered or used commercially. Endoscopy. Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, Texas Medical AssociationDisclosure: Nothing to disclose. http://creativecommons.org/licenses/by-nc-nd/4.0/ 32 (6):1003-9. Eventually, impaired venous return results in cardiac arrest and death. Derek J Roberts, Simon Leigh-Smith, Peter D Faris, Chad G Ball, Helen Lee Robertson, Christopher Blackmore, Elijah Dixon, Andrew W Kirkpatrick, John B Kortbeek, Henry Thomas Stelfox. Comparison of the efficacy of novel two covering methods for spontaneous pneumothorax: a multi-institutional study. Safety and effectiveness of a new fibrin pleural air leak sealant: a multicenter, controlled, prospective, parallel-group, randomized clinical trial. Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse. Rebecca Bascom, MD, MPH Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State College of Medicine, Milton S Hershey Medical Center; Graduate Faculty Member, Pennsylvania State University College of Medicine and The Huck Institutes of the Life Sciences [QxMD MEDLINE Link]. Central venous catheterization increases the risk of pneumothoraces when placed in the internal jugular or subclavian. Acta Pathol Jpn. 2007 Sep. 44 (9):588-93. (2005) Emergency medicine journal : EMJ. Shatz DV, de la Pedraja J, Erbella J, Hameed M, Vail SJ. J Ultrasound Med. BMJ Open Respir Res. Eur Respir J. Cameron PA, Flett K, Kaan E, Atkin C, Dziukas L. Helicopter retrieval of primary trauma patients by a paramedic helicopter service. Pneumothorax and pregnancy. [QxMD MEDLINE Link]. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Emerg Med Pract. 2022 Apr. Tension pneumothorax is a potentially life-threatening condition that medical professionals must treat as a medical emergency. 2009 Mar. Am J Emerg Med. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, Jiang GY. The risk of pneumothorax is greater with failed access at the initial vein, a subclavian vein approach, and positive pressure ventilation. Sanchez LD, Straszewski S, Saghir A, Khan A, Horn E, Fischer C, et al. Tagami R, Moriya T, Kinoshita K, Tanjoh K. Bilateral tension pneumothorax related to acupuncture. Presentation is variable and may initially have no symptoms. Symptoms may include: a sudden, sharp, stabbing pain in the . If patients become hemodynamically unstable or have a cardiac arrest, there is a high suspicion of tension pneumothorax. [QxMD MEDLINE Link]. The "lung point": an ultrasound sign specific to pneumothorax. In: StatPearls [Internet]. Barrios C, Tran T, Malinoski D, Lekawa M, Dolich M, Lush S, et al. Feldman AL, Sullivan JT, Passero MA, Lewis DC. Advanced trauma life support (ATLS): the ninth edition. [QxMD MEDLINE Link]. Ann Surg. On lung auscultation, decreased or absent breath sounds on the ipsilateral side, reduced tactile fremitus, hyper-resonant percussion sounds, and possible asymmetrical lung expansion are suggestive of pneumothorax. Marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax. POCUS has sensitivity and specificity ranging from 90-100% for detecting pneumothorax. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 2006 Mar. Ann Emerg Med. [QxMD MEDLINE Link]. Catheter aspiration for simple pneumothorax. Tension pneumothorax during flexible fiberoptic bronchoscopy in a newborn. Computed tomography scan demonstrating secondary spontaneous pneumothorax (SSP) from radiation/chemotherapy for lymphoma. 2005 Aug. 128 (2):720-8. Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration. British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. [Full Text]. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Melton LJ, Hepper NG, Offord KP. Chen JS, Hsu HH, Huang PM, Kuo SW, Lin MW, Chang CC, et al. With tension pneumothorax, patients will have signs of hemodynamic instability with hypotension and tachycardia. 1995 Oct. 108 (4):946-51. Eur Respir J. Close radiographic view of a small pneumothorax in a patient with idiopathic pulmonary fibrosis, following video-assisted thoracoscopic surgery (VATS) lung biopsy (same patient as in the previous image). Which of the following pulse pressures indicate early hypovolemic shock? Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation. Some options are abrasive scratchpad, dry gauze, or stripping of parietal pleura. Chemical pleurodesis is an alternative if the patient cannot tolerate mechanical pleurodesis. Cardiopulmonary imaging. [QxMD MEDLINE Link]. Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial. Hearnshaw SA, Oppong K, Jaques B, Thompson NP. Tension Pneumothorax Tension pneumothorax is the progressive built-up of air within the pleural space. Symptoms may include diaphoresis, splinting chest wall to relieve pleuritic pain, and cyanosis (in the case of tension pneumothorax). Dominguez KM, Ekeh AP, Tchorz KM, Woods RJ, Walusimbi MS, Saxe JM, McCarthy MC. In a small pneumothorax, many patients may present without symptoms. Atraumatic pneumothoraces are further divided into primary (unknown etiology) and secondary (patient with an underlyingpulmonary disease). Chen KY, Jerng JS, Liao WY, Ding LW, Kuo LC, Wang JY, Yang PC. Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine In some instances, subcutaneous emphysema can also be seen. JAMA. [QxMD MEDLINE Link]. 1997 Jun. Thorax. Ann Emerg Med. Subcutaneous emphysema. Pneumothorax is the collapse of the lung when air accumulates between the parietal and visceral pleura inside the chest. Ball CG, Kirkpatrick AW, Feliciano DV. [QxMD MEDLINE Link]. Shortness of breath/dyspnea in PSP is generally of sudden onset and tends to be more severe with SSPs because of decreased lung reserve. In this situation, the ipsilateral lung will, if normal, collapse completely (although a less than normally compliant lung may remain partially inflated). Rebecca Bascom, MD, MPH is a member of the following medical societies: American Thoracic SocietyDisclosure: Nothing to disclose. 2006 Jul. [QxMD MEDLINE Link]. There is atendency for the lung to recoilinward and the chest wall to recoil outward. Chest thoracostomy was performed, the patient was admitted, and talc pleurodesis was performed the next day.
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