Monday, November 12, 2007

Answer: VizD Challenge Week of 11/5/2007

Congratulations to Cristobal, this week's VizD winner.

Thank you to everyone who participated!

Cristobal is the winner of $5

A 42 year-old man presents to your ED with shortness of breath. His respiratory rate is 30 breaths per minute and saturation on room air is 80%. A CT scan is seen below.

(click on image to enlarge)
1. What is the diagnosis?
2.What is the immediate treatment?
3. What is the clinical triad associated with this diagnosis?

1. Tension pneumothorax
2. Needle decompression
3. Hypotension, decreased breath sounds, jugular venous distention

**Tension Pneumothorax is a clinical diagnosis and should never be identified on radiograph or CT scan!**

The Next VizD Will be Posted on November 26

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient. For more information please refer to the following link.


Adam said...

Please email me at to receive your $5 prize.

shadowfax said...

**Tension Pneumothorax is a clinical diagnosis and should never be identified on radiograph or CT scan!**

Oh, Bull poop. Maybe in the old days, when getting a chest x-ray was a big deal, or a time-consuming step involving the patient leaving the department.

But I can tell you that I have seen dozens of tension pneumothoraces in which a) the blood pressure was still normal, b) breath sounds were present and c) what's jugular venous distention? As if one can hear an asymmetry of breath sounds in that cacophony that is the ER anyway.... If the patient is in arrest, that is one thing, but if the patient is awake, a CXR is faster and more accurate diagnoses anyway.

Now, I have to admit a CT of the tension PTX is impressive, though!

Adam said...

Thanks for your comment. There is a difference between clinical tension pneumothorax and radiographic tension pneumothorax. In the latter, the patient should be STABLE. In a clinical tension pneumothorax, the patient generally is hypotensive and tachycardic due to compression of the inferior vena cava.