McPherson et al graded the chest radiograph findings associated with tension pneumothorax in combat casualties. The authors are from the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
NOTE: The discussion appears to be limited to a tension pneumothorax following injury to the left or right side, but not both.
Parameters:
(1) maximum pleural separation from chest wall
(2) mediastinal displacement
(3) tracheal deviation from midline
(4) displacement of the ipsilateral diaphragm
(5) compression of contralateral lung
|
Parameter |
Finding |
Points |
|
pleural separation |
<= 1 cm |
0 |
|
|
1.01 to 1.99 |
1 |
|
|
2.00 to 4.00 |
2 |
|
|
> 4 cm |
3 |
|
tracheal deviation from midline |
no |
0 |
|
|
yes |
1 |
|
displacement of diaphragm |
no |
0 |
|
|
yes |
1 |
|
compression of contalateral lung |
no |
0 |
|
|
yes with crowding of blood vessels |
1 |
|
|
yes with absence of aeration |
2 |
Mediastinal displacement:
(1) right sided injuries: right heart border displaced across the vertebral column
(2) left-sided injuries: left heart border in proximity to the vertebral column
|
Side of injury |
Distance of Right Heart from Midline |
Points |
|
right |
<= 1 cm to left of midline |
0 |
|
right |
1.01 to 1.99 cm to left of midline |
1 |
|
right |
2.00 to 4.00 cm to left of midline |
2 |
|
right |
> 4 cm to left of midline |
3 |
|
left |
<= 5.60 cm to right of midline |
0 |
|
left |
5.61 to 6.59 cm to right of midline |
1 |
|
left |
6.60 to 8.6 cm to right of midline |
2 |
|
left |
> 8.6 cm to right of midline |
3 |
where:
• The mean distance from midline to the right heart border was 4.6 cm in 50 casualities without significant chest injury.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the more severe the radiographic findings.
Specialty: Pulmonology
