Mediastinal pendulums

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Classification according to ICD-10
S22.3 Rib fracture
S22.4 Serial rib fracture
S27.0 Traumatic pneumothorax
S27.2 Traumatic hemopneumothorax
S27.7 Multiple injuries to intrathoracic organs
ICD-10 online (WHO version 2019)

As Mediastinalpendeln synchronous with respiration movements are mediastinal ( "mediastinum" ) designated in the horizontal direction. These can occur with various injuries to the chest .

Cause and effect

The cause is usually an open pneumothorax or an instability of the bony thorax as a result of rib series fractures with or without a fracture of the breastbone , which lead to pressure differences in the two halves of the chest and thus to a breathing-dependent displacement of the mediastinum to the side of the lower pressure. The mediastinal pendulum thus leads, in addition to the already existing failure of the injured lungs, to a reduction in the respiratory excursion of the uninjured lungs and thereby intensifies the disruption of gas exchange ( "pendulum air" ). In addition, compression of the superior vena cava ( superior vena cava ) can result, with reduced blood flow to the lungs and significant impairment of the entire blood circulation. The clinical picture can therefore quickly take an acutely life-threatening course.


The aim of the treatment is a quick normalization of the pressure conditions in the chest and lung function. Endotracheal intubation and ventilation may be necessary as a first emergency measure, but are often not sufficient in the case of tension pneumothorax . The open chest injury must be closed as quickly as possible, while the air is removed from the pleural space with the help of a biliary drainage . If the lungs themselves are injured to a large extent, it may be necessary to sew over this injury or, in extreme cases, even to partially remove the lungs ( lobectomy ).


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  • Doris Henne-Bruns, Bernd Kremer, Michael Dürig (Eds.): Surgery. = Dual series surgery. 3rd, completely revised and expanded edition. Thieme, Stuttgart 2008, ISBN 978-3-13-125293-7 , p. 991 ff.