Tension pneumothorax develops as air accumulates in the pleural space, compresses the lung, and shifts the mediastinum. The air that enters the pleural space is trapped and cannot escape during expiration. Tension pneumothorax typically occurs due to a lung or chest wall injury.
The symptoms are sudden in onset and include chest pain and dyspnea. On the affected side, there is hyperresonance to percussion and decreased or absent breath sounds. Additional findings include severe respiratory distress, tracheal deviation away from the affected side, hypotension, and jugular venous distention.
A delay in the diagnosis of tension pneumothorax can be fatal and treatment should not be delayed for any radiographic studies.
Once a clinical diagnosis is made, treatment consists of immediate needle decompression with a 14 or 16 gauge needle into the second intercostal space along the midclavicular line. This is followed by definitive treatment with tube thoracostomy.