Surgical Management Of Tension Pneumothorax

1. Tension Pneumothorax
Dr Massam
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2. Learning tasks
At the end of this session, students are expected
to be able to:
• Define tension pneumothorax
• Identify cause and risk factors
• Identify the differential diagnosis
• Describe pathophysiology and clinical features
• Manage tension pneumothorax
• Describe complications
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3. Introduction
• Pneumothorax is the presence of air outside
the lung, within the pleural space.
• Tension pneumothorax develops a lung or
chest wall injury is such that it allows air into
the pleural space but not out of it(a one-way
valve)

4. Introduction cont..
• Lung collapses first, and as air continuously
collects in the pleural cavity, mediastinum
shifts towards the opposite side, further
decreasing the volume of the functioning lung

5. Tension pneumothorax

6. Causes
• Trauma
• Infections such as emphysema
• Iatrogenic injury, such as insertion of a central
line or mediastina surgeries.
• Patients being mechanically ventilated
following trauma

7. Pathophysiology
• Any pleural breach can create valve-like
because air will find its way out through the
alveoli but cannot be drawn back in because
the lung tissue collapses around the hole in the
pleura.
• As a results, there is a build up of positive
pressure within the hemithorax, to the extent
that the lung is completely collapsed

8. Pathophysiology cont..
• This causes the diaphragm to flattened and the
mediastinum is distorted
• Also eventually, the venous return (from
inferior and superior venacava) to the heart is
compromised resulting into shock.

9. Chest x-ray

10. Clinical features
• Distended neck veins
• Hypotension or evidence of hypotension
• Diminished or absent breath sounds on the
affected side
• And trachea deviation to the contralateral side

11. Clinical features cont..
Other clinical features includes:-
• It can occur sudden/gradual
• Chest pain(sharp and stabbing) commonest but
may be absent in chronic cases
• Dyspnea frequent present associated with
cyanosis, sweating and fainting

13. Differential diagnosis
• Spontaneous pneumothorax
• Pericardial tamponade
• Rib fractures
• Pulmonary embolism
• Acute coronary syndrome

14. Investigations
• Chest x-ray will reveals
– Radiolucency on the affected side
– Absence of lung markings
– Collapsed lung margin
• Oxygen saturation.

15. Treatment
• Perform immediate needle decompression
–The most common approach to needle
decompression is to introduce a 14 to 16-
gauge IV needle and catheter into the
pleural space in the mid- clavicular line just
above the rib at the second intercostal space
• Followed by chest tube insertion with water
seal drainage.

16. Treatment cont..
• Also oxygen therapy if necessary
• Hospitalization and monitoring of the patient.

17. Complications
• Infections e.g empyema, lung abscess,
pneumonia, septicaemia.
• Respiratory failure
• Hemothorax etc

18. Key points
• Tension pneumothorax develops a lung or chest wall
injury is such that it allows air into the pleural space
but not out of it(a one-way valve)
• Tension pneumothorax is diagnosed clinically, before
the chest x-ray is obtained.
• Treatment include immediate needle decompression
followed by chest tube insertion with water seal
drainage.

19. Review questions
1. What is tension pneumothorax?
2. Mention cause for tension pneumothorax?
3.Outline management of tension
pneumothorax?
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20. References
• S.DAS,A Manual on clinical surgery 2011
• Bailey &Love’s short Practice of Surgery 26th
Edition
• SRB’s Manual of Surgery