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TENSION PNEUMOTHORAX
Pediatric Respirology Division

Helmi Lubis, dr, Sp.A(K)

Ridwan M. Daulay, dr, Sp.A(K)
Wisman Dalimunthe, dr, Sp.A
Rini S. Daulay, dr, M.Ked(Ped), Sp.A
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Pneumothorax
Abnormal collection of air in the
pleural space outside of the lung
Air enter the pleural space by a leak in
either the visceral or parietal pleura
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Classification of Pneumothorax:
Spontaneous:
Primary
Secondary
Traumatic
Iatrogenic
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Spontaneous Pneumothorax
Primary occurs without trauma or
underlying lung disease
Secondary complication of
underlying lung disorder:
Pneumonia
Pulmonary abscess
Asthma
Foreign body in the lung
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Traumatic Pneumothorax
Result of blunt or penetrating trauma
to the chest wall
Injury from a diagnostic or
therapeutic procedure Iatrogenic
Pneumothorax
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Iatrogenic Pneumothorax
Complicate of:
Tracheostomy
Thoracentesis
Transbronchial byopsi
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Catamenial Pneumothorax
Unusual condition
Associated with menses
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Clinical Manifestations
Sudden onset of chest pain
Tachypnea
Dyspnea
Tachycardia
Cyanosis
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Phisical Examination
Involved lung:
Decreased breath sounds
Percussion: hyperresonance
Larynx, trachea and heart shifted
toward unaffected side
Gurgling sounds synchronous with
respiration open fistula connecting
with air containing tissues
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Diagnosis
Radiographic examination:
Chest X Ray AP and lateral:
Air in the pleural space outlining the visceral
pleura/pleura line
Hyperlucency
Attenuation of vascular & lung marking on the
affected side
CT of the chest:
Detect bullae & blebs recurrent Pneumothorax
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Tension Pneumothorax ???

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Inspiration air enter the pleural

space
Exhalation air can not exit
Lead to collapse of the affected lung &
shift of mediastinum away from the
affected side
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Evidence of tension:
Shift of mediastinal structure away
from the side of air leak
Basis of evidence of:
Circulatory compromise
Hearing ahiss or rapid exit of the
air with the insertion of
thoracostomy tube
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Tension Pneumothorax causes:

Limit expansion of contralateral lung
May compromise venous return
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Definitive Treatment
Closed thoracotomy:
Drainage trapped air through a catheter
External opening in a dependent position
under water adequate to re-expand the
lung
Open thoracotomy:
Plication of blebs
Closure of fistula
Stripping of the pleura apical lung
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Chemical pleurodesis:
Talc
Tetracycline
Silver Nitrate
Pleural pain analgetic treatment
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