Presentation
Acute shortness of breath and right sided chest pain.
Patient Data
Age: 30 years
Gender: Male
From the case:
Tension pneumothorax
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- with the patient centrally positioned, there are increased right lung field lucency, and no pulmonary markings peripheral to the medially displaced shadow of the lateral/peripheral margin of the hyperdense smaller (collapsed) right lung
- relatively wide ipsilateral/right intercostal spaces
- shifting of mediastinal shadows to the contralateral/left side
- no obvious or definite evidence of other lesions
From the case:
Tension pneumothorax
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A right-sided chest tube was inserted, followed by clinical improvement, and subsequent imaging revealed:
- right-sided chest tube shadow
- the right lung's bronchovascular markings appear filling almost all the right lung field, with remnant rim of lucency peripherally and superiorly
- no deviation of mediastinal shadow
- bilaterally, the intercostal spaces appear symmetrical
- multiple air-density foci in the right thoracic wall's soft tissue shadow around the site of chest tube insertion
Case Discussion
The initial radiograph shows features of a right-sided tension pneumothorax. In the absence of any underlying cause, it has to be considered as a primary spontaneous one.
The follow-up radiograph after insertion of a chest tube shows a successful right lung re-expansion with a small residuum and subcutaneous emphysema around chest tube insertion site.
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