Tension Pneumothorax without Apparent Tracheal Deviation: Two Cases

Abstract

Tracheal deviation is a recognized and important sign of tension pneumothorax. However, we report two cases in which patients receiving high levels of positive-pressure ventilation developed tension pneumothorax but did not exhibit palpable tracheal deviation. On a chest radiograph of one of these patients, the portion of the trachea containing the endotracheal tube appeared virtually midline, whereas the trachea was seen to be deviated below the level of the endotracheal tube. Thus, the presence of a relatively rigid endotracheal tube may explain the absence of the tracheal deviation that otherwise would be expected in association with a tension pneumothorax. The absence of palpable tracheal deviation in the presence of other appropriate findings should not delay immediate decompression of a tension pneumothorax.