A tension pneumothorax is a complete collapse of the lung. It occurs when air enters, but does not leave, the space around the lung (pleural space).

See also: Pneumothorax

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

As the amount of trapped air increases, pressure builds up in the chest. The lung collapses on that side and can 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 can cause the other lung to become compressed, and can affect the flow of blood returning to the heart.

This situation can lead to low blood pressure, shock, and death.

• 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
• Decreased consciousness
• Rapid breathing
• Bulging (distended) veins in the neck

When heard through a stethoscope, the breath sounds are decreased. Structures in the center of the chest (mediastinum) may appear to have moved. There may be air trapped in the tissue of the chest wall (subcutaneous emphysema), 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 tests are done. Some tests can help confirm the diagnosis and determine the severity of the problem.

Tests used to diagnose tension pneumothorax include:

• A chest x-ray
• Arterial blood gases
• Electrocardiogram

If you have symptoms of tension pneumothorax, get immediate medical treatment.

Treatment removes the air from the pleural space, allowing the lung to re-expand. In an emergency, a small needle (such as a standard intravenous needle) may be placed into the chest cavity through the ribs to relieve pressure.

The standard treatment is a chest tube, a large plastic tube that is inserted through the chest wall between the ribs to remove the air. The chest tube is attached to a vacuum bottle that slowly removes air from the chest cavity. This allows the lung to re-expand. As the lung heals and stops leaking air, the vacuum is turned down and then the chest tube is removed. Some people might need to stay in the hospital to have the chest tube checked, and because it can take several days for the affected lung to fully re-expand.

Surgery may be needed if the problem happens again, or if the lung does not re-expand after 5 days with a chest tube in place.

Up to 50% of patients who have a pneumothorax will have another. There are no long-term complications after successful treatment.

• Acute respiratory failure
• Air in the mediastinal space, which can interfere with heart and lung function (pneumomediastinum)
• Very low blood pressure (shock)
• Death

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of this disorder.

Take care to avoid chest trauma. Many cases are not preventable.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000. 

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.