Cardiothoracic Surgery |

Is Tension Pneumothorax a Radiological Diagnosis or Should It Remain a Clinical Diagnosis? FREE TO VIEW

John Agapian, MD; Yuxuan Wang, MD; Jose Tschen, MD; Afshin Molkara, MD
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University of California, Riverside, CA

Chest. 2014;145(3_MeetingAbstracts):29A. doi:10.1378/chest.1780893
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SESSION TITLE: Surgery Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Tension Pneomothorax is a life threatening emergency, and often diagnosed clinically, with hypotension, hypoxia, absent breath sounds, and tracheal deviation. Rarely, will a CXR be available, as these patients are clinically too unstable; a CXR would show accumulation of air under pressure in the pleural space, resulting in a mediastinal shift.

CASE PRESENTATION: Acute Care Surgery team was consulted for a 57 y/o male with concern for tension pneumothorax given following CXR (Figure 1). This was followed by CT chest (Figure 2). The patient was hemodynamically stable, and had CXR performed as part of his routine office check up visit. Review of the imagining studies suggested this to be a giagantic bleb and not a tension pneumothorax. Thoracic surgery service was consulted, and Video-Assisted Thoracoscopic Surgery (VATS) was performed, which showed a giagantic bleb adhessed to the chest wall; the bleb was resected.

DISCUSSION: Patients who have clinical suspicion for a tension pneumothorax should undergo immediate decompression, usually with needle decompression, followed by thoracostomy tube placement. On the other hand, if someone is otherwise clinically stable, and presents with a CXR similar to figure 1, then they may have a giagantic bleb instead. Placing a chest tube into a gigantic bleb may result in a bronchopleural fistula and a persistant air leak.

CONCLUSIONS: Accumulation of air under pressure in the pleural space resulting in a mediastinal shift does not neccessarily indicate a tension pneumothorax and may not warrent placement of emergent chest tube, unless they have associated clinical signs and symptoms of a tension pneumothorax. In our case, the patient had giagantic bleb that was successfully treated with an elective VATS.

Reference #1: Vega ME, Civic, B. A Tension Bulla Mimicking Tension Pneumothorax. N Engl J Med 2011; 365:1915

Reference #2: Mehran RJ, Deslauriers J. Indications for Surgery and Patient Work-up for Bullectomy. Chest Surg Clin N Am 1995; 5(4);717-34

DISCLOSURE: The following authors have nothing to disclose: John Agapian, Yuxuan Wang, Jose Tschen, Afshin Molkara

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