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What is a Tension Pneumothorax?
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Overview

Tension pneumothorax can occur without any prior lung conditions or diseases. In most cases, a tension pneumothorax results from the rupture of blebs (air-filled sac on the lung). As a result, air escapes from the lung and enters the chest cavity causing the lung to collapse. It differs from spontaneous pneumothroax in that the collapse is much more severe and can cause many serious medical problems.

As the air escapes from the lung and enters the pleural space, increased pressure can cause a mediastinal shift, in which the heart, trachea, and great vessels are pushed towards the unaffected side of the chest.

This can be a life-threatening emergency.

Causes

Causes of a tension pneumothorax differ depending on each situation. A penetrating trauma to the chest, lung infection, or a recurrent prior pneumothorax may all lead to a tension pneumothorax.

The reason why this occurs is unclear, although spontaneous pneumothorax has been attributed to tall, thin men (between 20 and 40 years of age); smokers; and in some cases, women during their menstrual cycles.


Images

Click here to view an x-ray of a pneumothorax (source: Yale)



Symptoms

  • sudden chest pain

  • shortness of breath

  • chest tightness

  • easy fatigue

  • rapid heart rate

  • bluish color of the skin caused by lack of oxygen

  • pain in the arm

  • stabbing sensation in the back



  • Detection and Tests

    Using a stethoscope, a doctor may be able to determine decreased breathing sounds, and a possible collapse.

  • chest x-ray

  • arterial blood gases



  • Treatment

    The goal of treatment is to remove the air from the pleural space so that the lung can re-expand.

    Tension pneumothorax requires immediate chest-tube insertion to allow the air to be released and the lung to re-expand.

    Recurrent cases of pneumothoraces may require surgery to eliminate the chance of having future episodes.

    Recurrent cases of spontaneous pneumothorax may become more serious. An x-ray is the only reliable method in determing the severity of each pneumothorax.

    Prevention

    The only known way of preventing a pneumothorax is to reduce the risk by not smoking.

    Prognosis

    Depending on the cause, as many as 50% of patients with a pneumothorax experience recurrence.

    Call 911 if...

    If you believe that you have a tension pneumothorax call an ambulance immediately.



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