Tension pneumothorax

Causes and Risks:
In tension pneumothorax, air enters the pleural space with each breath, is not expelled by exhaling, and becomes trapped. The trapped air builds up pressure in the chest, as the amount of trapped air accumulates. If untreated, the lung collapses on the affected side and may cause a mediastinal shift in which the heart, trachea, esophagus, and great vessels are pushed towards the unaffected side of the chest. The shift may cause compression of the opposite lung and may affect the flow of blood returning to the heart. Causes include penetrating trauma to the chest, lung infection, mechanical ventilation with high pressures, and as a complication of cardio-pulmonary resuscitation. Tension pneumothorax is a life-threatening emergency.

Prevention:
Use precautions to avoid chest trauma. Lung infections should be treated promptly. Many cases are not preventable.

Symptoms:



Signs and Tests:
Physical examination may show decreased breath sounds when listening to the chest with a stethoscope. There may be evidence of mediastinal shift (heart, trachea, esophagus and great vessels shifted towards unaffected lung). Subcutaneous emphysema (air trapped in the subcutaneous tissue of the chest wall) may be present, causing a spongy feeling when the chest is felt with the hands ( palpation ).

Tests used in the diagnosis of tension pneumothorax include:



Treatment:
The objective of treatment is to remove the air from the pleural space, allowing the lung to re-expand. A chest tube is inserted through the chest wall between the ribs. The chest tube is attached to a vacuum bottle which slowly and continuously 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. Hospitalization is usually required since it may take several days to fully re-expand the lung.

Surgery may be indicated for recurrent episodes or if the lung does not re-expand after 5 days with a chest tube in place.

Prognosis:
Up to 50% of patients with spontaneous pneumothorax experience recurrence. There are no long term complications following successful therapy.

Complications:

  • acute respiratory failure
  • pneumomediastinum (air in the mediastinal space, which can interfere with heart and lung functioning)



Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of this disorder are present.


Pneumothorax occurs when air leaks from inside of the lung to the space between the lung and the chest wall. The lung then collapses. The dark side of the chest (right side of the picture) is filled with air that is outside of the lung tissue.