Needle thoracostomy fails to detect a fatal tension pneumothorax

Ann Emerg Med. 1993 May;22(5):863-6. doi: 10.1016/s0196-0644(05)80809-1.


Needle thoracostomy is an emergency procedure used to both diagnose and initially treat a tension pneumothorax. We report a case of fatal tension pneumothorax in an intubated patient with chronic obstructive pulmonary disease that was missed by this technique. A tension pneumothorax involving only the right middle and lower lobes was found at autopsy. The autopsy also suggested that needle thoracostomy was misleading because it sampled air from a noncommunicating bulla in the right upper lobe rather than from the pleural space. Tension physiology can exist with only localized collapse of a lung, and diagnostic needle thoracostomy can be falsely negative. When tension pneumothorax is strongly suspected, if empiric thoracentesis does not vent air under pressure, subsequent tube thoracostomy is indicated.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged
  • Humans
  • Lung Diseases, Obstructive / complications
  • Male
  • Needles
  • Pneumothorax / complications
  • Pneumothorax / diagnosis*
  • Respiratory Insufficiency / etiology*
  • Thoracostomy*