Pneumothorax, Tension pneumothorax, Surgical emphysema

Pneumothorax (air in pleural space with associated collapsed lung) -

• look around periphery of lung
• identify edge of collapsed lung
• one half of lung may seem more radiolucent than the other (which is radio-opaque)
• area beyond the collapsed lung will be very radiolucent (no pulmonary vessel marking)

Tension Pneumothorax (air enters pleural space via a hole in the ling surface or the chest wall, but because of ball-valve effect, air cannot leave by the same route)

• air accumulates in the pleural space
• pushes the mediastinum over to the opposite (=normal) side
• compresses normal lung –> less inspiration occurs on the normal side
• compresses heart –> decrease venous return until patient arrests

Summary

There is no shift in mediastinum and therefore no tension pneumothorax

There is shift of mediastinum away from the side of pneumothorax indicating a R/L tension pneumothorax. This is a medical emergency which I would treat immediately by inserting a large bore cannula into the R/L pleural space

Surgical Emphysema

• Air in soft tissue

Others

• Air in mediastinum