A young lady is brought to emergency department following stab injury to right chest. She is gasping for breath, with tachypnoea, distended neck veins and tracheal shift to left on examination. There is hyperresonance and absent breath sounds on right hemithorax. The most probable diagnosis is
right tension pneumothorax
The correct answer is right tension pneumothorax. Penetrating trauma creates a one-way valve: air enters the pleural space but cannot escape. Rising intrapleural pressure collapses the lung (absent breath sounds, hyperresonance), pushes the mediastinum and trachea to the opposite side (tracheal shift to the left) and kinks the great veins, causing distended neck veins and obstructive shock. It is a clinical diagnosis: treat by immediate needle decompression (5th intercostal space, anterior axillary line per ATLS) then intercostal drainage, never awaiting a radiograph.
Simple pneumothorax also gives hyperresonance and absent breath sounds but without mediastinal shift, raised JVP or shock. Cardiac tamponade shares hypotension and distended neck veins (Beck's triad) but the trachea is central and the chest is dull with normal breath sounds. Hydropneumothorax gives basal dullness with a fluid level and no acute tracheal deviation.
Key point: Hyperresonance plus tracheal shift away from the lesion plus distended neck veins equals tension pneumothorax; dullness with a central trachea equals tamponade.
Similar Questions
Consider the following statements regarding flail chest:
1. Three or more ribs are fractured at two or more places.
2. The chest wall shows paradoxical motion.
3. An X-ray chest AP view is the gold standard for diagnosis.
4. Treatment involves oxygen support, analgesia and physiotherapy.
Which of the statements given above are correct?
Important Questions from Chest & Lung Surgery
- Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:
- A 50-year old male with significant smoking history presented in the surgical emergency with sudden severe breathlessness. Chest X-ray shows right sided Pneumothorax. The appropriate management requires:
- During subclavian vein puncture in a surgical ward suddenly a patient developed severe breathlessness. On auscultation breath sound was absent and the ipsilateral chest was tympanitic on percussion. The probable diagnosis is:
- A 50 year old male presented with pain along the left arm and ptosis. His chest X-ray showed soft tissue opacity at the apex of the left lung along with the erosion of the adjacent rib. The probable diagnosis is:
- Which of the following are the Indications for lung transplantation?
1. Emphysema
2. Primary pulmonary hypertension
3. Obliterative bronchiolitis
Select the correct answer using the code given below:
