Tension Pneumothorax – Radiology Board Review
- Clinical: Tension pneumothorax is a life-threatening condition characterized by respiratory distress, tracheal deviation, distended neck veins, hypotension, and decreased breath sounds; it can occur in any age group but is more common after trauma or certain medical procedures.
- Etiology/Pathophys: Tension pneumothorax occurs when air enters the pleural space but cannot escape, leading to increased intrapleural pressure, which can cause lung collapse, mediastinal shift, and cardiovascular compromise.
- Radiograph: Key findings include ipsilateral hypertransradiancy, lung collapse, mediastinal shift away from the affected side, depressed diaphragm, and splayed ribs.
- US: Ultrasound can confirm a pneumothorax, and in the setting of tension pneumothorax, it may show a fixed, dilated inferior vena cava and cardiac tamponade-like signs such as right ventricular underfilling.
- CT: While not typically used for initial diagnosis, CT scans can provide more detailed images of the lung and pleural space, helping to evaluate complications or underlying conditions.
- Signs: Deep sulcus sign (depressed diaphragm) and sail sign (mediastinal shift) are notable radiological signs.
- Frameworks: No specific staging system; diagnosis is primarily clinical.
- DDx: Cardiac tamponade (right ventricular diastolic collapse), massive pulmonary embolism (sudden onset of hypoxia and hypotension without tracheal deviation).
- Tx: Immediate needle decompression followed by insertion of a chest tube for definitive management.
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