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.
Important Questions from Chest & Lung Surgery
Which of the following are correct for herniation via foramen of Morgagni?
1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia.
Select the answer using the code given below.
A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is $26$ breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagno- sis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left second intercostal space should be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
Select the correct answer using the code given below :
- A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagno-sis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left second intercostal space should be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
Select the correct answer using the code given below : - 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:
