Images in Clinical Medicine
Spontaneous Tension Pneumothorax
N Engl J Med 2010; 362:e43March 25, 2010
- Article
A 19-year-old man presented to the emergency department with a 2-day history of shortness of breath and pain on the right side of the chest. He reported no history of trauma, smoking, or respiratory illness, and there was no family history of emphysema or connective-tissue disease. On physical examination, his respiratory rate was 40 breaths per minute; oxygen saturation, 97% while he was breathing ambient air; heart rate, 130 beats per minute; and blood pressure, 140/80 mm Hg. A chest examination revealed decreased breath sounds on the right side accompanied by resonance on percussion. A chest film showed tension pneumothorax, with marked leftward deviation of the trachea, heart, and mediastinum and herniation of air across the midline (Panel A, arrows). A chest tube was inserted, and symptoms resolved immediately. A subsequent chest film obtained 6 hours later showed partial expansion of the collapsed lung (Panel B, arrowheads); the chest tube can also be seen (arrows). The lung fully expanded after a few days. Computed tomography of the thorax revealed no emphysematous changes. The patient was discharged without a clear determination of the cause of his condition.
Eli Ben-Chetrit, M.D.
Ofer Merin, M.D.
Shaare Zedek Medical Center, Jerusalem, Israel
elibc1@yahoo.com
