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Citation, DOI & article dataCitation: Gaillard, F., Bickle, I. Tension pneumothorax. Reference article, Radiopaedia.org. (accessed on 05 Nov 2022) https://doi.org/10.53347/rID-15362 Tension pneumothoraces occur when intrapleural air accumulates progressively with hemodynamic compromise 10. It is a life-threatening occurrence requiring both rapid recognition and prompt treatment to avoid a cardiorespiratory arrest. For a general discussion, refer to the pneumothorax article. On this page:A non-tension pneumothorax is properly called a simple pneumothorax. Presentation is variable and may initially have no symptoms. With time severe dyspnea, tachycardia and hypotension occur. Distended neck veins and tracheal deviation are also often present. Eventually, impaired venous return results in cardiac arrest and death. This can occur within minutes. Clinical signs of a tension pneumothorax in the ventilated patient are comparably rapid, with arterial and mixed venous peripheral capillary oxygen saturation immediately decreasing 5. A tension pneumothorax occurs due to the progressive accumulation of intrapleural gas in thoracic cavity caused by a valve effect during inspiration/expiration. In this situation, the ipsilateral lung will, if normal, collapse completely (although a less than normally compliant lung may remain partially inflated). In either case, as the collection grows further, it exerts a positive mass effect on the mediastinum (compression of vessels and heart) and the opposite lung. A tension pneumothorax will have the same features as a simple pneumothorax with a number of additional features, helpful in identifying tension. These additional signs indicate hyperexpansion of the hemithorax:
In the rare instance of bilateral tension pneumothoraces, there may be no cardiomediastinal shift 6,7. UltrasoundIn addition to the sonographic features of pneumothorax, a RUSH exam (often performed in the setting of hemodynamic instability) the following features imply the presence of tension physiology 8:
Treatment and prognosisTreatment of a tension pneumothorax is one of the classic medical emergencies where life can be saved or lost on the basis of recognition and subsequent rapid decompression. Numerous techniques exist, and the literature is replete with opinions, but in the first instance relieving the tension, even if not draining the pneumothorax, is life-saving. A needle thoracostomy (e.g. 14G intravenous cannula) can be inserted, typically in the 2nd intercostal space in the midclavicular line, to gain valuable time, before a larger underwater drain can be inserted 1.
Promoted articles (advertising)OverviewA pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. A pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures, or damage from underlying lung disease. Or it may occur for no obvious reason. Symptoms usually include sudden chest pain and shortness of breath. On some occasions, a collapsed lung can be a life-threatening event. Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own. SymptomsThe main symptoms of a pneumothorax are sudden chest pain and shortness of breath. Severity of symptoms may depend on how much of the lung is collapsed. When to see a doctorSymptoms of a pneumothorax can be caused by a variety of health problems, and some can be life-threatening, so seek medical attention. If your chest pain is severe or breathing becomes increasingly difficult, get immediate emergency care. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health
information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. CausesA pneumothorax can be caused by:
Risk factorsIn general, men are far more likely to have a pneumothorax than women are. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is very tall and underweight. Underlying lung disease or mechanical ventilation can be a cause or a risk factor for a pneumothorax. Other risk factors include:
ComplicationsPotential complications vary, depending on the size and severity of the pneumothorax as well as the cause and treatment. Sometimes air may continue to leak if the opening in the lung won't close or pneumothorax may recur. Pneumothorax care at Mayo Clinic May 21, 2021
RelatedAssociated ProceduresProducts & ServicesHow can you tell the difference between pneumothorax and tension pneumothorax?Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse. It can happen secondary to trauma (traumatic pneumothorax). When mediastinal shifts accompany it, it is called a tension pneumothorax. This is a life-threatening emergency that needs urgent management.
What are signs and symptoms of a tension pneumothorax?Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. Symptoms include chest pain, shortness of breath, rapid breathing, and a racing heart, followed by shock.
What are 3 signs and symptoms of a pneumothorax?What are the Symptoms of Pneumothorax?. Sharp, stabbing chest pain that worsens when trying to breath in.. Shortness of breath.. Bluish skin caused by a lack of oxygen.. Fatigue.. Rapid breathing and heartbeat.. A dry, hacking cough.. How can you tell the difference between pneumothorax?They are:. traumatic pneumothorax. This occurs when an injury to the chest (as from a car wreck or gun or knife wound) causes the lung to collapse.. tension pneumothorax. This type can be fatal. ... . primary spontaneous pneumothorax. This happens when a small air bubble on the lung ruptures. ... . secondary spontaneous pneumothorax.. |
What are the signs and symptoms of a pneumothorax compared to a tension pneumothorax?
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