ICU Chest Films > Air in the Chest > Pneumothorax > Tension Pneumothorax

Tension Pneumothorax

A tension pneumothorax in the ICU patient is a clinical diagnosis based on ventilatory and cardiac compromise. Radiographically, a tension pneumothorax in an ICU patient can be an extremely challenging diagnosis. Parenchymal disease such as ARDS may reduce lung compliance such that total lung collapse in the face of a tension pneumothorax may not occur. Mediastinal shift is usually seen in a tension pneumothorax, but the use of PEEP may prevent this from occurring. The most reliable sign of tension pneumothorax is depression of a hemidiaphragm. Other signs of tension pneumothorax include shifting of the heart border, the superior vena cava, and the inferior vena cava. The shifting of these structures can lead to decreased venous return.

This patient is suffering from a right tension pneumothorax.