Page 26 - Delaware Medical Journal - July 2016
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FIGURE 1
AP x-ray of the chest demonstrating left hemithorax opacification and leftward mediastinal shift consistent with atelectatic collapse of the left lung.
FIGURE 2
AP x-ray of the chest demonstrating a large right-sided pneumothorax with apical, lateral, and basilar components (solid white arrows).
Intubation Barotrauma and/or CPR Causing Tension Pneumoperitoneum
Background: Review the radiologic findings and clinical significance of tension pneumoperitoneum.
Case Report: Imaging case presented to radiology during patient’s prolonged and complicated hospital stay.
Conclusions: Tension pneumoperitoneum associated with barotrauma is a rare, but potentially life threatening complication of mechanical ventilation. The radiologist should be able to recognize the imaging findings associated with tension pneumoperitoneum in order to assist in diagnosis of this potentially reversible entity.
Keywords: Tension pneumoperitoneum, Barotrauma, Intubation, CPR, Radiology
CASE REPORT
A 62-year-old gentleman with a long standing history of continued tobacco abuse and COPD requiring home oxygen, with which he is noncompliant, presented comatose with a PCO2 of 123. After demonstrating no improvement after one hour
of noninvasive positive pressure ventilation, the decision was made to intubate the patient. Subsequently, complete left sided atelectasis (Figure 1) developed which prompted exchange of the endotracheal tube. Initial ventilation settings included a FiO2 of 100 percent, tidal volume of 500 ml, positive end-expiratory
pressure of 14 cm H2O, and a respiratory rate of 28 breaths/ minute, which were changed to a tidal volume of 350 ml and respiratory rate of 32 breaths/minute due to high plateau pressures greater than 50 cm H2O. Ventilation was further complicated by copious airway excretions. Before a chest x-ray could be obtained, the patient became hemodynamically unstable and deteriorated
to pulseless electrical activity, with CPR initiated and return of
chest x-ray (Figure 2) demonstrated a right-sided pneumothorax, which was clinically determined to be under tension, based on
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Del Med J | July 2016 | Vol. 88 | No. 7
Abstract
