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Tension Pneumothorax

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Tension Pneumothorax

Tension Pneumothorax is A life-threatening form of pneumothorax in which
progressively increasing pressure within the pleural space causes severe respiratory and
cardiovascular compromise. It is a clinical diagnosis that requires immediate treatment.

ICD-10

J93

Specialty

Pulmonology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

A one-way valve mechanism allows air to enter the pleural space during inspiration but
prevents it from escaping. Progressive pressure compresses the lungs and mediastinal
structures, leading to impaired ventilation, decreased venous return, reduced cardiac
output, hypoxia, and hemodynamic instability.

Etiology & Risk Factors

Causes
• Disruption of the:
• Visceral pleura
• Parietal pleura
• Tracheobronchial tree
May occur as:
• Complication of spontaneous pneumothorax
• Traumatic pneumothorax

Pathophysiology

Pathophysiology:
1. Disruption of the pleura or tracheobronchial tree.
2. One-way valve mechanism develops.
3. Air enters the pleural space during inspiration but cannot escape.
4. Progressive accumulation of intrapleural air increases intrathoracic pressure.
5. Collapse of the ipsilateral lung.
6. Compression of:
• Contralateral lung
• Trachea
• Heart
• Superior vena cava
• Angulation of the inferior vena cava
7. Reduced venous return.
8. Reduced cardiac output.
9. Hypoxia and hemodynamic instability.

Clinical Presentation

Patients May Develop

  • Respiratory compromise
  • Hypoxia
  • Hemodynamic instability

An Unstable Patient May Have

  • Respiratory rate >24/min
  • SpO₂ <90% on room air
  • Heart rate <60 or >120/min
  • Hypotension
  • Inability to speak in complete sentences due to dyspnea

History Taking

-Assess for:
• Sudden onset respiratory symptoms
• Recent spontaneous pneumothorax
• Chest trauma
• Rapid clinical deterioration

Physical Examination

Assess:
• Respiratory rate
• Heart rate
• Blood pressure
• Oxygen saturation
• Ability to speak in complete sentences
• Signs of respiratory distress
• Hemodynamic instability

Investigations

• Diagnosis is primarily clinical.
• Serial chest X-rays after emergency treatment.
• Continuous pulse oximetry.
• Continuous telemetry

Diagnosis

Diagnosis is based on:
• Clinical evidence of progressive respiratory and cardiovascular compromise.
• Imaging should not delay emergency treatment.

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Management of Tension Pneumothorax​

Immediate management
• Administer 100% FiO₂ (high-concentration supplemental oxygen).
• Avoid positive-pressure ventilation.
• Perform emergency needle decompression in hemodynamically unstable patients.
• Usually in the 5th intercostal space, anterior to the midaxillary line.
• Immediately follow with tube thoracostomy (chest tube).
• Continuous telemetry.
• Continuous pulse oximetry.
• Serial chest X-rays after decompression.
• ICU transfer

Complications of Tension Pneumothorax​

• Ipsilateral lung collapse
• Compression of the contralateral lung
• Compression of the heart
• Compression of the superior vena cava
• Reduced venous return
• Reduced cardiac output
• Severe hypoxia
• Hemodynamic instability

Prognosis of Tension Pneumothorax​

  • Prognosis depends on rapid recognition and immediate decompression.
  • Delayed
    treatment may rapidly result in severe cardiorespiratory compromise.

Key Points / Clinical Pearls of Tension Pneumothorax​

• Medical emergency.
• Caused by a one-way valve mechanism.
• Air enters but cannot leave the pleural space.
• Progressive pressure compresses thoracic organs.
• Causes hypoxia and hemodynamic instability.
• Diagnosis is clinical.
• Never delay treatment for imaging.
• Immediate needle decompression followed by chest tube insertion.
• Administer 100% oxygen.
• ICU monitoring after stabilization.