Tension Pneumothorax
A life-threatening collapsed lung that compresses the heart
Quick Facts
- Type: Respiratory emergency
- Problem: Trapped air collapses a lung under pressure
- Key signs: Severe breathlessness, chest pain, low blood pressure
- Action: Call emergency services immediately
Overview
A pneumothorax is a collapsed lung that happens when air leaks into the space between the lung and the chest wall. A tension pneumothorax is the most dangerous form, in which air keeps entering this space with each breath but cannot escape. The trapped air builds up under increasing pressure, fully collapsing the lung and pushing the heart and the other lung toward the opposite side of the chest.
This rising pressure squeezes the heart and the large blood vessels, reducing the heart's ability to pump blood. Without rapid treatment, blood pressure falls and the condition can quickly become fatal. Tension pneumothorax is a true medical emergency that requires immediate recognition and treatment to release the trapped air and restore breathing and circulation.
What makes the tension type so dangerous, compared with an ordinary collapsed lung, is the rising pressure. As air keeps accumulating with no way out, it not only stops the lung from working but also squeezes the heart and great vessels, so the heart cannot fill and pump properly. This is why blood pressure can fall so rapidly and why treatment cannot wait.
Symptoms
Symptoms come on suddenly and worsen rapidly as pressure builds.
- Sudden, severe shortness of breath
- Sharp chest pain, often on one side
- Rapid breathing and a fast heart rate
- Low blood pressure, with light-headedness or collapse
- Bluish lips or skin from lack of oxygen
- Distended neck veins and, in some cases, the windpipe appearing pushed to one side
- Severe distress and a feeling of impending doom
This combination of severe breathlessness, chest pain, and signs of shock is a medical emergency. Call emergency services immediately.
Causes
Tension pneumothorax develops when a one-way air leak lets air build up in the chest.
- Chest injury: A penetrating or blunt injury, such as from trauma or a rib fracture, that lets air enter and become trapped.
- Mechanical ventilation: Pressure from a breathing machine can force air into the chest space.
- Underlying lung disease: A leak from conditions such as COPD or a ruptured air pocket (bleb) in the lung.
- Medical procedures: Some chest procedures can accidentally cause an air leak.
In each case, air enters the chest space during breathing but cannot get out, so pressure rises steadily.
Risk Factors
- Major chest trauma or penetrating chest injury
- Being on a mechanical ventilator
- Underlying lung diseases such as COPD or asthma
- A previous pneumothorax
- Certain chest or lung procedures
Diagnosis
Because it is rapidly fatal, tension pneumothorax is often diagnosed clinically and treated before imaging.
- Clinical signs: Severe breathlessness, low blood pressure, absent breath sounds on one side, and a windpipe pushed to the opposite side may prompt immediate treatment without waiting for tests.
- Chest X-ray: Confirms a collapsed lung and shifting of chest structures, when time allows.
- Ultrasound: Can quickly detect a pneumothorax at the bedside.
- CT scan: Provides detail in stable patients but is not used when treatment cannot wait.
Treatment
Treatment is urgent and aims to release the trapped air immediately.
- Emergency needle decompression: A needle is inserted into the chest to let the trapped air escape and relieve the pressure right away.
- Chest tube placement: A tube is inserted into the chest space to continuously drain the air and allow the lung to re-expand.
- Oxygen and supportive care: To support breathing and circulation.
- Treating the cause: Repairing injuries, adjusting ventilator settings, or managing underlying lung disease.
Prompt decompression can rapidly reverse a deteriorating, life-threatening situation.
Prevention
- Tension pneumothorax often cannot be prevented, but prompt treatment of a simple pneumothorax can stop it from progressing
- Follow your care plan if you have lung disease such as COPD or asthma
- Seek prompt care for chest injuries
- If you have had a pneumothorax before, discuss precautions, such as around air travel and diving, with your doctor
When to See a Doctor
Tension pneumothorax is a life-threatening emergency. Call emergency services immediately for sudden, severe shortness of breath and chest pain, especially with light-headedness, fainting, bluish lips, or a fast heartbeat, and most urgently after a chest injury. Do not wait, and do not attempt to drive yourself. Rapid emergency treatment to release the trapped air can be lifesaving.
Frequently Asked Questions
What is a tension pneumothorax?
It is the most dangerous form of collapsed lung, in which air becomes trapped in the chest and builds up under pressure with each breath. The pressure fully collapses the lung and pushes on the heart and other lung, reducing blood flow and threatening life.
How is it different from a regular pneumothorax?
A simple pneumothorax is a collapsed lung where leaked air does not keep building. In a tension pneumothorax, a one-way leak lets air accumulate under rising pressure, compressing the heart and causing dangerously low blood pressure, which makes it a true emergency.
What are the warning signs?
Warning signs include sudden severe shortness of breath, sharp one-sided chest pain, a fast heartbeat, low blood pressure, light-headedness or collapse, and bluish lips. These signs together, especially after a chest injury, require calling emergency services at once.
How is a tension pneumothorax treated?
Treatment is urgent and starts with releasing the trapped air, often by inserting a needle into the chest (needle decompression), followed by a chest tube to drain the air and re-expand the lung. Oxygen, supportive care, and treating the cause follow.
Can it be fatal?
Yes. Without rapid treatment, the rising pressure can stop the heart from pumping enough blood, leading quickly to shock and death. This is why immediate emergency care is essential.
References
- MedlinePlus, U.S. National Library of Medicine. Collapsed lung (pneumothorax).
- Mayo Clinic. Pneumothorax — Symptoms and causes.
- American Lung Association. Pneumothorax.
- National Heart, Lung, and Blood Institute (NHLBI). Pneumothorax.