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21st February 2025
Tension pneumothorax
Tension pneumothorax is a medical emergency. It occurs when a one-way valve develops between the pleural cavity and the external environment, leading to progressive entry of air into the pleural space during inspiration, which is unable to be expelled. The resultant increase in intrathoracic pressure leads to reduced venous return, impaired cardiac output and haemodynamic collapse.
Differences in presentation and management of tension pneumothorax compared to other types of pneumothorax are outlined below:
| Aetiology | More common with traumatic than spontaneous pneumothorax. |
| Symptoms | More severe breathlessness and chest pain; feeling of dread or panic. |
| Signs | Tachycardia, hypotension, sweating, more severe hypoxia and respiratory distress.
Tracheal deviation away from the side of the pneumothorax. |
| Imaging | Management should commence as soon as tension pneumothorax is suspected before imaging.
If an X-ray is done, it may show a mediastinal shift away from pneumothorax. |
| Management | Immediate decompression with a large-bore cannula in the 2nd intercostal space, mid-clavicular line. Chest drain insertion following decompression. |
Table 11 Features, investigations and management of tension pneumothorax
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