Thursday, November 13, 2014


A man is brought in by ambulance after a motor vehicle accident with a dramatic open chest wound. The wound is on the left chest. During inspiration, the wound makes a big sucking noise and the mediastinum swings to the right. During expiration, the mediastinum returns to midline. When you look into the wound, during expiration, the injured lung inflates.

Challenge: What's going on here?

Image shown under Creative Commons Attribution Share-Alike License, from Wikipedia.


RaH said...

My guess would be a perforation of the thorax with pleura and lung resulting in a tension pneumothorax creation.

Craig Chen said...

that's the right thought

This is an open pneumothorax where ambient air enters through a traumatic chest wall defect during inspiration (a sucking wound). During expiration, air exits the pleural space through the chest wall defect and expiratory air from the normal lung fills the collapsed lung (pendulum air) leading to mediastinal flutter.

Source: UpToDate.