Tension pneumothorax is a critical medical condition characterized by the accumulation of air in the pleural space, leading to increased intrathoracic pressure that can compromise respiratory and cardiovascular function. This condition arises when air enters the pleural cavity during inspiration but cannot escape during expiration, creating a “one-way valve” effect that progressively elevates intrapleural pressure. As a result, the affected lung collapses, and mediastinal structures are displaced towards the opposite side, which can severely impair venous return and cardiac output, potentially leading to cardiovascular collapse if not promptly treated.
Clinically, tension pneumothorax presents with a range of symptoms including acute chest pain, tachypnea, respiratory distress, hypotension, and tracheal deviation away from the affected side. The absence of breath sounds on the affected side and distended neck veins may also be observed. The diagnosis is often supported by imaging, particularly chest X-rays, which may reveal mediastinal shift and lung collapse. However, the absence of classic signs can complicate diagnosis, especially in patients under anesthesia or those with altered consciousness.
The management of tension pneumothorax is urgent and typically involves decompression of the pleural space. This can be achieved through needle thoracostomy, which provides immediate relief by allowing trapped air to escape, followed by definitive treatment such as tube thoracostomy. Failure to recognize and treat tension pneumothorax can lead to high mortality rates, underscoring the importance of rapid diagnosis and intervention.
In summary, tension pneumothorax is a life-threatening condition that requires swift clinical recognition and intervention to prevent severe respiratory and cardiovascular complications. Its management is critical in emergency settings, particularly in trauma cases or during surgical procedures where the risk of pneumothorax is heightened.
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Amaniti, A., Provitsaki, C., Papakonstantinou, P., Tagarakis, G., Sapalidis, K., Dalakakis, I., … & Grosomanidis, V. (2019). Unexpected tension pneumothorax-hemothorax during induction of general anaesthesia. Case Reports in Anesthesiology, 2019, 1-4. https://doi.org/10.1155/2019/5017082
Clark, S., Ragg, M., & Stella, J. (2003). Is mediastinal shift on chest x‐ray of pneumothorax always an emergency?. Emergency Medicine, 15(5-6), 429-433. https://doi.org/10.1046/j.1442-2026.2003.00497.x
Hamamoto, N., Kikuta, S., Takahashi, R., & Ishihara, S. (2023). Delayed tension hemothorax with nondisplaced rib fractures after blunt thoracic trauma. Cureus. https://doi.org/10.7759/cureus.38835
Han, K., Kim, H., Byon, H., Kim, J., Kim, H., Kim, C., … & Kim, S. (2010). Cardiac arrest induced by tension pneumothorax during ventilating bronchoscopy -a case report-. Korean Journal of Anesthesiology, 59(2), 123. https://doi.org/10.4097/kjae.2010.59.2.123
Haq, E. and Omar, B. (2014). Traumatic tension pneumothorax as a cause of icd failure: a case report and review of the literature. Case Reports in Cardiology, 2014, 1-4. https://doi.org/10.1155/2014/261705
Harar, R., Pratap, R., Chadha, N., & Tolley, N. (2005). Bilateral tension pneumothorax following rigid bronchoscopy: a report of an epignathus in a newborn delivered by the exit procedure with a fatal outcome. The Journal of Laryngology & Otology, 119(5), 400-402. https://doi.org/10.1258/0022215053945813
Kang, S., Kim, Y., & Kim, D. (2022). A rare complication: tension pneumothorax after peroral endoscopic myotomy. International Journal of Gastrointestinal Intervention, 11(3), 139-142. https://doi.org/10.18528/ijgii210057
Lee, S., Seo, K., Kim, Y., Youn, E., Lee, J., Park, J., … & Moon, H. (2020). Cardiac arrest caused by contralateral tension pneumothorax during one-lung ventilation – a case report -. Anesthesia and Pain Medicine, 15(1), 78-82. https://doi.org/10.17085/apm.2020.15.1.78
No, M., Moon, S., & Kim, H. (2012). Contralateral tension pneumothorax during one lung ventilation by a univent® tube. Yeungnam University Journal of Medicine, 29(1), 31. https://doi.org/10.12701/yujm.2012.29.1.31
Quinn, N., Palmer, C., Bernard, S., Noonan, M., & Teague, W. (2019). Thoracostomy in children with severe trauma: an overview of the paediatric experience in victoria, australia. Emergency Medicine Australasia, 32(1), 117-126. https://doi.org/10.1111/1742-6723.13392
Sakuraba, S., Omae, T., Koyanagi, I., Koh, K., & Inada, E. (2018). Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report. Ja Clinical Reports, 4(1). https://doi.org/10.1186/s40981-018-0184-z
Shetawi, A., Golden, L., & Turner, M. (2016). Anesthetic complication during maxillofacial trauma surgery: a case report of intraoperative tension pneumothorax. Craniomaxillofacial Trauma & Reconstruction, 9(3), 251-254. https://doi.org/10.1055/s-0036-1572504
Yoon, J., Choi, S., Suh, J., Jeong, J., Lee, B., Park, Y., … & Park, C. (2013). Tension pneumothorax, is it a really life-threatening condition?. Journal of Cardiothoracic Surgery, 8(1). https://doi.org/10.1186/1749-8090-8-197
