Ultrasound Findings in Tension Pneumothorax: A Case Report.
BACKGROUND
Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described.


METHODS
We report the case of a 21-year-old man with sudden-onset left-sided chest pain. He was clinically stable without hypoxia or hypotension, and the initial chest x-ray study showed a large pneumothorax without mediastinal shift. While the patient was awaiting tube thoracostomy, a point-of-care ultrasound demonstrated findings of mediastinal shift and a dilated inferior vena cava (IVC) concerning for tension physiology, even though the patient remained hemodynamically stable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates a unique clinical scenario of ultrasound evidence of tension physiology in a clinically stable patient. Although this patient was well appearing without hypotension, respiratory distress, tracheal deviation, or distended neck veins, point-of-care ultrasound revealed mediastinal shift and a plethoric IVC. Given that the classic clinical signs of tension pneumothorax are not uniformly present, this case shows how point-of-care ultrasound may diagnose tension pneumothorax before clinical decompensation.
Mt. Sinai St. Luke's/West Hospital System, New York, New York.
Maxine
M
Inocencio
Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California.
Jeannine
J
Childs
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
Mikaela L
ML
Chilstrom
Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California.
Kristin
K
Berona
D004452:Echocardiography / Q000379:methods; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis*; D019095:Point-of-Care Systems; D011859:Radiography / Q000379:methods; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
emergency medicine; shock; tension pneumothorax; ultrasound findings