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Tension pneumothorax in a newborn after Cesarean-section delivery -A case report-

Kim SK, Kim WH - Korean J Anesthesiol (2010)

Bottom Line: Immediately after delivery, the newborn was found to be breathless with a heart rate <60/min.The severe acidosis was corrected with sodium bicarbonate.The patient was managed in the neonatal intensive care unit, but died from uncorrectable acidosis.

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea.

ABSTRACT

Tension pneumothorax in newborns is a rare but life-threatening complication. We encountered a case of a full-term neonate with a breech presentation. An elective cesarean section was scheduled. Immediately after delivery, the newborn was found to be breathless with a heart rate <60/min. During intubation and cardiac massage, the patient's femoral artery and vein were accessed. The infantogram revealed a right side tension pneumothorax. A 22 gauge needle thoracentesis relieved the right side chest pressure and a closed thoracostomy was performed. The severe acidosis was corrected with sodium bicarbonate. The patient was managed in the neonatal intensive care unit, but died from uncorrectable acidosis. We report this case with a review of the relevant literature.

The portable infantogram reveals a right side tension pneumothorax. Massive air collection is observed in the right lung field, which caused right lung to collapse completely. The mediastinal structures are shifted to the left side and a linear low density exists in the mediastinum, which is considered to be pneumomediastinum. Subcutaneous emphysema on the supraclavicular area can be seen on both sides.
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Figure 1: The portable infantogram reveals a right side tension pneumothorax. Massive air collection is observed in the right lung field, which caused right lung to collapse completely. The mediastinal structures are shifted to the left side and a linear low density exists in the mediastinum, which is considered to be pneumomediastinum. Subcutaneous emphysema on the supraclavicular area can be seen on both sides.

Mentions: The infantogram revealed massive air collection in the right lung field and a mediastinal shift to the left side, which is considered to be a tension pneumothorax (Fig. 1). It took 30 minutes to diagnose the tension pneumothorax. Needle thoracostomy was performed in the right second intercostal space on the midclavicular line with a 22 guage intravenous cannula and decompression with 10 ml syringe was started. The blood pressure after several decompressions was 80/60 mmHg, and the heart rate was 130 beats/min.

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Tension pneumothorax in a newborn after Cesarean-section delivery -A case report-

Kim SK, Kim WH - Korean J Anesthesiol (2010)

The portable infantogram reveals a right side tension pneumothorax. Massive air collection is observed in the right lung field, which caused right lung to collapse completely. The mediastinal structures are shifted to the left side and a linear low density exists in the mediastinum, which is considered to be pneumomediastinum. Subcutaneous emphysema on the supraclavicular area can be seen on both sides.
© Copyright Policy - open-access
Figure 1: The portable infantogram reveals a right side tension pneumothorax. Massive air collection is observed in the right lung field, which caused right lung to collapse completely. The mediastinal structures are shifted to the left side and a linear low density exists in the mediastinum, which is considered to be pneumomediastinum. Subcutaneous emphysema on the supraclavicular area can be seen on both sides.
Mentions: The infantogram revealed massive air collection in the right lung field and a mediastinal shift to the left side, which is considered to be a tension pneumothorax (Fig. 1). It took 30 minutes to diagnose the tension pneumothorax. Needle thoracostomy was performed in the right second intercostal space on the midclavicular line with a 22 guage intravenous cannula and decompression with 10 ml syringe was started. The blood pressure after several decompressions was 80/60 mmHg, and the heart rate was 130 beats/min.

Bottom Line: Immediately after delivery, the newborn was found to be breathless with a heart rate <60/min.The severe acidosis was corrected with sodium bicarbonate.The patient was managed in the neonatal intensive care unit, but died from uncorrectable acidosis.

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea.

ABSTRACT

Tension pneumothorax in newborns is a rare but life-threatening complication. We encountered a case of a full-term neonate with a breech presentation. An elective cesarean section was scheduled. Immediately after delivery, the newborn was found to be breathless with a heart rate <60/min. During intubation and cardiac massage, the patient's femoral artery and vein were accessed. The infantogram revealed a right side tension pneumothorax. A 22 gauge needle thoracentesis relieved the right side chest pressure and a closed thoracostomy was performed. The severe acidosis was corrected with sodium bicarbonate. The patient was managed in the neonatal intensive care unit, but died from uncorrectable acidosis. We report this case with a review of the relevant literature.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3022137&rFormat=json&query=null&req=5