Tension pneumothorax – time to change the old mantra?

 

The universal mantra from medical school of the 2nd ICS mid clavicular line approach is not wrong, it’s just that it might not work in a worst case of up to 50% of trauma patients. We all need to be cognisant that if the patient is obese or has a reasonable pectoral muscle mass, the 5th ICS mid axillary line should be the second port of call, or for some, may even be a more appropriate first line approach.

Hydropneumothorax in a post pneumonectomy patient

Hydropneumothorax in a post pneumonectomy patient. Note the perfectly horizontal fluid line due to a true air-fluid interface rather than a fluid meniscus that would be typical of a pleural effusion in the absence of a pneumothorax. Also note the volume loss on the effected side rather than positive mass effect consistent with the lung having been removed.