Tension pneumothorax: a difficult diagnosis

Abstract

A 63 year old white man presented to the accident and emergency department with a 24 hour history of gradual onset of mild weakness of his left upper limb, which progressed to involve his left lower limb. There was no history of any other CNS symptoms. He also stated that the paresis varied with posturebeing worse on standing and sitting, while it was relieved by lying down; it was also associated with a noticeably diminished shortterm memory over the past few weeks. Clinical examination confirmed a mild left hemiparesis (grade 4/5), with brisk reflexes and an "equivocal" plantar response on the left. The rest of the examination was unremarkable: he was normotensive, no carotid bruits were auscultated and the fundi were normal. Haematological and biochemical investigations were normal.

Self-Assessment Exercises In Pre-Hospital Emergency Trauma Care

“…preterminal sign (16). Drainage in the second intercostal space, mid-clavicular line is not always successful due to a number of reasons (17,18).…”

Bilateral Tension Pneumothoraces Leading to Cardiac Arrest after Coronary Artery Bypass Surgery

“…Several reports of diagnostic difficulties and pitfalls had led up to delay or missed diagnosis due to the existence of the missing classic signs. 9,10 Our experience with the presented case calls for a heightened awareness in poststernotomy patients who are presenting with progressive diffuse thoracic pains coupled with respiratory distress and confusion. The elimination of thoracic pain sensation at first with peripheral analgetics and later using central analgetics in our patient may have potentially further masked the symptoms preceding the deterioration.…”

Thoracic abnormal air collections in patients in the intensive care unit: radiograph findings correlated with CT

“…Tension pneumothorax is characterized by an abnormal increase in the pressure of the involved thoracic cavity. A one-way valve between the involved lung and the pleura leads to the continuous leakage of air into the pleural cavity and causes the accumulation of air within the pleural cavity [30]. Next, the ipsilateral lung collapses, the mediastinum is displaced away from the affected side, and the ipsilateral diaphragm is displaced downwards (especially in positive pressure ventilation) and may invert downwards [30].…”