Some symptoms of tension pneumothorax include shortness of breath, sharp chest pain, and blue or discolored skin, lips, or nails. Tension pneumothorax is a medical emergency.

Pneumothorax occurs when air collects or accumulates in the space between the chest wall and the lung, which doctors refer to as the pleural cavity. This causes the lung to deflate or collapse either fully or partially.

Tension pneumothorax is a variant of a pneumothorax. The condition also results from air collecting in the pleural cavity, but the pressure buildup in the pleural cavity causes the mediastinum to shift toward the unaffected lung.

The mediastinum is the space that contains the heart, trachea, important blood vessels, and other essential body parts. When it shifts toward the unaffected lung, it compresses its contained structures, leading to life threatening symptoms.

This article discusses the signs of a tension pneumothorax, along with its causes, diagnosis, and treatment. The article also explores the outlook for people who have experienced tension pneumothorax.

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The signs of tension pneumothorax may include:

Symptoms of a tension pneumothorax can progress to respiratory arrest, which means a person completely stops breathing. A 2015 study found that 9.3% of tension pneumothorax cases involving people who did not receive ventilatory assistance progressed to respiratory arrest.

Tension pneumothorax is a medical emergency — a person should call 911 immediately if they recognize or experience any signs of the condition.

Various injuries, complications from surgery, and medical conditions can lead to tension pneumothorax.

Researchers do not know the exact incidence of the condition, but it may occur in about 1–3% of prehospital, ICU, and major trauma patients.

A pneumothorax only begins to shift and compress the mediastinum when there is air tension developing in the space around the lung leading to tension pneumothorax.

A simple pneumothorax where there is no shift in the mediastinum can progress to a tension pneumothorax. Other potential causes of a tension pneumothorax may include:

According to 2021 research, doctors often diagnose tension pneumothorax through a clinical assessment according to a person’s symptoms.

If someone is experiencing hemodynamic instability, which refers to issues with blood flow in the body, and acute respiratory failure, healthcare professionals may use a bedside chest ultrasound to help confirm a diagnosis. However, if an ultrasound is not readily available, they may only use a clinical assessment to diagnose the condition before performing emergency treatment.

If a person is hemodynamically stable, a healthcare professional may use a chest X-ray to confirm a tension pneumothorax diagnosis. If the chest X-ray is unclear, they may also use a chest CT scan to confirm the diagnosis.

Someone who finds a person unconscious with breathing difficulties or who has sustained trauma should let emergency rescue professionals know the situation. Cardiac arrest can also present with pneumothorax as the cause.

A tension pneumothorax is a medical emergency, and people require treatment quickly to increase their likelihood of survival. Treatment for the condition may include:

  • Needle decompression: This procedure involves a healthcare professional inserting a hollow needle into the space between the ribs to extract air from the pleural cavity.
  • A chest tube: Doctors insert a chest tube to remove air from the pleural cavity.
  • Oxygen therapy: Tension pneumothorax may lead to decreased oxygen levels. A healthcare professional may administer supplemental oxygen to help improve a person’s oxygen levels.
  • Respiratory support: If someone still has problems breathing after a needle decompression, mechanical ventilation may help. Doctors typically avoid using mechanical ventilation initially as it may increase the size of the tension pneumothorax.

Less commonly, doctors need to perform a surgical technique, such as a thoracotomy, to stop the air leak. However, in about 90% of cases, a chest tube remains sufficient to treat the leak.

Various factors may affect a person’s outlook, such as the cause of the tension pneumothorax, underlying health problems, and access to prompt treatment.

A 2015 systematic review found the mortality rate for a tension pneumothorax was 6.7% in people with unassisted breathing and 22.7% in those who received breathing assistance with mechanical ventilation.

The length of time it takes for someone to fully recover from a tension pneumothorax varies. Typically, healthcare professionals recommend a person takes certain precautions to prevent a reoccurrence of pneumothorax. For example, usually, doctors recommend not flying for at least 2–4 weeks after treatment.

As always, a person should follow instructions from a healthcare professional.

Possible complications of tension pneumothorax include:

  • pneumothorax recurrence
  • respiratory failure
  • respiratory arrest
  • cardiac arrest
  • air in the abdominal cavity
  • air in the pericardial space, the area between the heart and the sac that surrounds it
  • hemothorax, when an injury or other factor causes blood to collect in the chest
  • bronchopleural fistula, when an atypical passageway or connection between the pleural cavity and the airways in the lungs develops

Tension pneumothorax involves air in the space between the chest wall and lung that causes a shift of the mediastinum, which contains the heart and other vital body parts. This shift puts pressure on and compresses the unaffected lung and mediastinum.

The condition is a medical emergency that can cause increased heart rate, low blood pressure, and breathing difficulty. It requires immediate treatment, which may include needle decompression, insertion of a chest tube, oxygen therapy, or surgery.

A person should call 911 immediately if they recognize or experience any signs of tension pneumothorax.