CXR Case 099

41 year old male. Motor vehicle accident 30 minutes ago. Driver, no airbag, bent steering wheel. Alert complaining of chest pain.

CXR CASE 099 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is a left pneumothorax with mediastinal shift suggesting a tension. No obvious rib fracture(s).


CLINICAL CORRELATION

Tension pneumothorax
This needs immediate recognition and a needle decompression.


CLINICAL PEARLS

Studies suggest that between 10-20% of the population may have a chest wall thickness greater than the length of a 14 or 16G cannula in the (classic) 2nd intercostal space, mid clavicular line.

If you can’t access the pleural space here then go for the 5th intercostal space, anterior to the mid axillary line where there is no pectoral muscle to venture across. If thickness of adipose tissue is a problem – you will need to perform a blunt dissection – just use your finger – ‘a finger thoracostomy’.


TOP 150 CXR SERIES



Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.