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Tension Pneumothorax

By

Thomas G. Weiser

, MD, MPH, Stanford University School of Medicine

Last full review/revision Jun 2020| Content last modified Jun 2020
CLICK HERE FOR THE PROFESSONAL VERSION

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.

  • Doctors can usually diagnose tension pneumothorax based on the person's history, symptoms, and examination results.

  • Doctors immediately insert a large needle into the chest to remove the air.

In an ordinary pneumothorax Pneumothorax A pneumothorax is the presence of air between the two layers of pleura (thin, transparent, two-layered membrane that covers the lungs and also lines the inside of the chest wall), resulting... read more Pneumothorax , injury to a lung allows a certain amount of air to enter the space between the lung and the chest wall (pleural space). Typically, the air stops accumulating. However, in tension pneumothorax, air continues to enter the pleural space as the person breathes and pressure rises inside the chest. The rise in pressure reduces the amount of blood returning from the body to the heart because the blood cannot force its way into the chest and back to the heart. As a result, the heart has less blood to pump to the body, resulting in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . These effects can occur rapidly, particularly in people using a mechanical ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more . Tension pneumothorax can rapidly be fatal.

Symptoms of Tension Pneumothorax

At first, people have chest pain, feel short of breath, breathe rapidly, and feel that their heart is racing. As the pressure inside the chest increases, blood pressure drops dangerously low (shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more ), people feel weak and dizzy, and the veins of the neck may bulge.

Diagnosis of Tension Pneumothorax

  • A doctor's evaluation

Doctors diagnose tension pneumothorax based on the person's history, symptoms, and examination results. For example, one side of the chest may bulge (be distended), and doctors may hear a hollow sound when they tap it. When they listen to the chest with a stethoscope, they may not hear any air flowing to the lung.

Because tension pneumothorax is an emergency, doctors begin treatment immediately rather than doing tests.

Treatment of Tension Pneumothorax

  • Needle decompression

Doctors immediately insert a large needle into the pleural space to remove the air (called needle decompression). Then a chest (thoracostomy Chest Tube Insertion Chest tube insertion (also called tube thoracostomy) is a procedure in which a tube is inserted into the space between the lung and chest wall (called the pleural space). The procedure is done... read more ) tube is inserted to continue to drain air and allow the lung to reinflate. Usually local anesthesia is used.

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