title: Needle thoracostomy fails to detect a fatal tension pneumothorax.
abstract: Needle thoracostomy is an emergency procedure used to both diagnose and initially treat a tension pneumothorax. We report a case of fatal tension pneumothorax in an intubated patient with chronic obstructive pulmonary disease that was missed by this technique. A tension pneumothorax involving only the right middle and lower lobes was found at autopsy. The autopsy also suggested that needle thoracostomy was misleading because it sampled air from a noncommunicating bulla in the right upper lobe rather than from the pleural space. Tension physiology can exist with only localized collapse of a lung, and diagnostic needle thoracostomy can be falsely negative. When tension pneumothorax is strongly suspected, if empiric thoracentesis does not vent air under pressure, subsequent tube thoracostomy is indicated.
authors.affiliation: Emergency Department, University of Pennsylvania, Philadelphia.
authors.forename: D
authors.initials: D
authors.lastname: Mines
authors.forename: S
authors.initials: S
authors.lastname: Abbuhl
mesh_terms: D000208:Acute Disease; D000368:Aged; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications; D008297:Male; D009339:Needles; D011030:Pneumothorax / Q000150:complications / Q000175:diagnosis*; D012131:Respiratory Insufficiency / Q000209:etiology*; D013907:Thoracostomy