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Abstract
Bilateral tension pneumothorax occurring as a result of recreational activity is exceedingly
rare. A 10-year-old boy with no previous respiratory symptoms was involved in a bicycleto-bicycle collision during play. He was the only one hurt. A few hours later, he was rushed
to the general casualty unit of the emergency department of our institution with respiratory
distress, diminished bilateral chest excursions and diminished breath sounds. The correct
diagnosis was made after a chest radiograph was obtained in the course of resuscitation at
the casualty unit. Pleural space needle decompression was suggestive of tension only on
the right. Bilateral tube thoracostomies provided effective relief. He was discharged from
hospital after a week in excellent health. This case illustrates the need for children to have
safety instruction to reduce the risks of recreational bicycling. Chest radiography may be
needed to establish the diagnosis of bilateral tension pneumothorax. Needle thoracostomy
decompression is not always effective.
Page
Background
young
boy
following
an
Page
was
erroneous.
The
Figure 1
Chest x-ray showing bilateral tension
pneumothorax.
Differential diagnosis
tension
this
pneumothorax
evidenced
by
was
questionable.
When
the
cardiothoracic
spontaneous
team
was
pneumothorax,
contacted,
possibly
After
the
bilateral
tube
Treatment
Resuscitation included administration of
high flow oxygen by reservoir bag.
Needle decompression of the pleural
space using a 16 gauge over-the-needle
cannula (inserted full length, about 4.5
cm into the fifth interspace, mid-axillary
line) was performed. This produced a
brief hiss of air on the right but not on the
left side. Chest tube insertion was then
performed on the right and subsequently
Page
Discussion
Although BTP of any aetiology is rare,
unilateral tension pneumothorax (UTP) is
not uncommon following blunt chest
trauma. A pneumothorax after blunt chest
trauma results when a fractured rib is
driven inwards to cause a lung puncture
or laceration. It may also result from
sudden compression of the chest with a
closed
glottis
without
rib
fracture.
Figure 2
Post-tube
thoracostomy
chest
x-ray
pneumothorax.
Page
childhood
injury,
is
more
likely
above
injuries
displays
common
most
probable
mechanical
the
sport.
We
certainly
encourage
presentation
bilateral
at
the
casualty.
Other
tension
complicates
the
fractures
and
cycling.
causing
pneumothorax
bicycles
as
means
of
and
adopted
in
several
examination
the
pneumothorax.
clinician,
would
have
likelihood
of
The
however,
unsuspecting
is
unlikely
to
Page
taught
classical
signs
of
tension
prevent fatality.
pneumothorax
must
be
appreciated.
tension
investigation
suspected
in
the
patient
tension
with
to
established
tension
Learning points
have
been
Failure
pneumothorax.
pneumothorax.5,8
provide
decompression or confirmation
decompression,
chest
wall
thickness
consistently
effective
recreational bicycling.
Footnotes
Competing interests: none.
on
the
right
side.
Page
Patient
consent:
Patient/guardian
REFERENCES
pneumothoraxtime
of
the
human
chest,
KW,
MacQuarrie
re-think?
[PubMed]
3.
for a
MB.
eyes
may
be
more
pneumothorax.
Resuscitation
51720 [PubMed]
4. Levy AS, Bassett F, Lintner S, et al.
Pulmonary barotrauma:
diagnosis
in
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