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Tension pneumothorax is a life-threatening condition where air enters the pleural space and cannot escape, leading to progressive accumulation of intrapleural pressure. This results in lung collapse, mediastinal shift, and compromise of venous return to the heart, causing respiratory and circulatory failure.

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Etiopathogenesis

Mechanism:

• A one-way valve is created at the site of lung or chest wall injury.
• Air enters the pleural cavity during inspiration but is trapped during expiration.
• This increased intrathoracic pressure causes:
  • Collapse of the ipsilateral lung.
  • Shift of the mediastinum to the contralateral side.
  • Compression of the contralateral lung and great vessels (e.g. vena cava).

Common Causes:

• Penetrating or blunt chest trauma.
• Barotrauma from mechanical ventilation.
• Ruptured pulmonary blebs (often in tall, thin individuals or those with underlying lung disease).
• Procedural complications (e.g. central venous catheter insertion, thoracentesis).

Clinical Presentation

Acute, rapid onset symptoms:

• Severe dyspnea
• Unilateral pleuritic chest pain
• Tachycardia and hypotension
• Distended neck veins (due to impaired venous return)
• Tracheal deviation away from affected side (late sign)