eMedicine Specialties > Trauma > Thoracic Trauma

Tension Pneumothorax: Workup

Author: H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
Contributor Information and Disclosures

Updated: May 15, 2009

Workup

Laboratory Studies

  • Although laboratory and imaging studies help determine a diagnosis, tension pneumothorax primarily is a clinical diagnosis based on patient presentation. Do not delay delivery of treatment modalities while waiting for imaging or laboratory studies.
  • Arterial blood gas (ABG) studies show varying degrees of acidemia, hypercarbia, and hypoxemia, the occurrence of which depends on the extent of cardiopulmonary compromise at the time of collection.

Imaging Studies

  • Suspicion of tension pneumothorax, especially in late stages, mandates immediate treatment and does not require potentially prolonged diagnostic studies.
  • Ultrasonography provides a rapid imaging option for diagnosis of pneumothorax, but this evaluation should NOT delay treatment of a clinically apparent tension pneumothorax.13,14,15
  • X-rays
    • X-rays showing tension pneumothorax often show 2 problems: first, the presence of tension pneumothorax, and second, the fact that an x-ray procedure was performed rather than emergent life-saving chest decompression (see Image 1 or below).
      This picture shows a chest radiograph with 2 abno...

      This picture shows a chest radiograph with 2 abnormalities: (1) tension pneumothorax and (2) potentially life-saving intervention delayed while waiting for x-ray results. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation.

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      This picture shows a chest radiograph with 2 abno...

      This picture shows a chest radiograph with 2 abnormalities: (1) tension pneumothorax and (2) potentially life-saving intervention delayed while waiting for x-ray results. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation.

    • In the rare case that a chest x-ray is obtained safely, findings can include ipsilateral lung collapse at the hilum, trachea and mediastinum deviation to the contralateral side, and widened intercostal spaces on the affected side (see Images 5-6 or below). With a left hemithorax, the left hemidiaphragm may be depressed, but the liver prevents this occurrence on the right side.
      An older man was admitted to the intensive care u...

      An older man was admitted to the intensive care unit (ICU) postoperatively. Note the right-sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right-sided bronchial tree. Marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax. The endotracheal tube is in a good position.

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      An older man was admitted to the intensive care u...

      An older man was admitted to the intensive care unit (ICU) postoperatively. Note the right-sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right-sided bronchial tree. Marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax. The endotracheal tube is in a good position.


      Right main stem intubation resulting in left-side...

      Right main stem intubation resulting in left-sided tension pneumothorax, right mediastinal shift, deep sulcus sign, and subpulmonic pneumothorax.

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      Right main stem intubation resulting in left-side...

      Right main stem intubation resulting in left-sided tension pneumothorax, right mediastinal shift, deep sulcus sign, and subpulmonic pneumothorax.

More on Tension Pneumothorax

Overview: Tension Pneumothorax
Workup: Tension Pneumothorax
Treatment: Tension Pneumothorax
Follow-up: Tension Pneumothorax
Multimedia: Tension Pneumothorax
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Clinical Trials

National Guideline Clearinghouse

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Keywords

tension pneumothorax, pneumothorax, collapsed lung, lung collapse, pneumomediastinum, air in intrapleural space, blunt chest injury, penetrating chest injury, needle thoracostomy, tube thoracostomy, chest tube, tension percutaneous aspiration, chest trauma, transthoracic needle aspiration, therapeutic thoracentesis, central venous catheter insertion, positive pressure mechanical ventilation, intrapleural air, perivascular alveolar rupture

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Contributor Information and Disclosures

Author

H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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