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Tension viscerothorax: an important differential for tension pneumothorax
  1. B McCann,
  2. A O’Gara
  1. Emergency Department, Waterford Regional Hospital, Ireland
  1. Correspondence to:
 Dr B McCann
 Emergency Department, Waterford Regional Hospital, Ireland;

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We describe a case of acute tension viscerothorax secondary to blunt vehicular trauma causing diaphragmatic rupture. With sufficient gastric herniation to cause mediastinal shift and haemodynamic compromise, the clinical presentation may mimic that of tension pneumothorax. Tension viscerothorax is not referred to in the Advanced Trauma and Life Support1 (ATLS) manual.


A 70 year old male pedestrian was struck by a fast moving motor vehicle. On arrival at a local community hospital he was haemodynamically stable with blood pressure, heart rate, and respiratory rate all within normal range. Positive examination and radiological findings included a right pubic ramus fracture, and an undisplaced right fibular fracture. Ten hours later he was transferred to a trauma facility for further management of his orthopaedic injuries.

During transfer the patient deteriorated and on arrival at the regional trauma facility the patients respiratory …

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