Tension pneumothorax

Alternative names

Pneumothorax - tension

Definition

A tension pneumothorax is a complete collapse of the lung that occurs when air enters but does not leave the space around the lung (pleural space). It is a potentially life-threatening condition which can lead to dangerously low oxygen levels, shock, or death. See also pneumothorax.

Causes, incidence, and risk factors

Any condition that leads to pneumothorax can cause a tension pneumothorax. In an uncomplicated pneumothorax, air can enter and leave the pleural space easily. In tension pneumothorax, however, air enters the pleural space with each breath and becomes trapped there.

As the amount of trapped air accumulates, pressure builds up in the chest. The lung collapses on that side and may push the important structures in the center of the chest (such as the heart, major blood vessels, and airways) toward the other side of the chest. The shift may cause compression of the opposite lung and may affect the flow of blood returning to the heart.

This situation can lead to Low Blood pressure, shock, and death. Tension pneumothorax is a life-threatening emergency.

Symptoms

• sudden chest pain
  
• Shortness of breath
  
• chest tightness
  
• easy fatigue
  
• bluish color of the skin due to lack of oxygen
  
• rapid heart rate
  
• Low Blood pressure
  
• decreased mental alertness
  
• consciousness, decreased
  
• breathing, rapid
  
• distended neck veins (the veins in the neck appear to bulge)
  

Signs and tests

Physical examination may show decreased breath sounds when listening to the chest with a stethoscope. Structures in the mediastinum (center of the chest) may appear shifted. Subcutaneous emphysema (air trapped in the subcutaneous tissue of the chest wall) may be present, causing a spongy feeling when the chest is felt with the hands (palpation).

In general, if a health care provider suspects tension pneumothorax, treatment should start before diagnostic tests are done. Nonetheless, some tests may help confirm the diagnosis if there is doubt or to assess the severity of the situation: