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Potentially life-threatening emergency
Tension pneumothorax in Adult
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Potentially life-threatening emergency

Tension pneumothorax in Adult

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Contributors: Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

This is a medical emergency.

In tension pneumothorax, pleural pressure ipsilateral to the affected lung increases with the accumulation of air in the pleural space. Pressure in the pleural space exceeds atmospheric pressure throughout the entire respiratory cycle, especially during expiration. Associated with the occurrence of a bronchopleural fistula, a persistent air leak into the pleural space that allows air to enter during inspiration but prevents it from exiting during expiration; this mechanism is akin to a one-way valve.

With progression, positive pleural pressure shifts the mediastinum away from the affected lung and toward the contralateral lung, further comprising ventilation and leading to respiratory failure. Progressive mediastinal shift interferes with venous return and leads to reduced cardiac output and, eventually, cardiovascular collapse and death.

Mechanisms of bronchopleural fistula formation include:
  • Alveolar rupture (due to barotrauma in mechanically ventilated patients, especially with high tidal volumes, high positive end-expiratory pressure [PEEP] settings, and development of auto PEEP); underlying infection, inflammation, or malignancy; resuscitation efforts
  • Injury to the visceral pleura (as with surgery, biopsy, thoracentesis, chest tube placement, central line placement, direct trauma)
  • Necrotizing infections (Staphylococcus aureus pneumonia, tuberculosis)
Related topic: Pneumothorax

Codes

ICD10CM:
J93.0 – Spontaneous tension pneumothorax

SNOMEDCT:
233645004 – Tension pneumothorax

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Other etiologies of PEA:
Severe emphysematous lung disease may masquerade as a pneumothorax on radiographic or ultrasound imaging.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 08/25/2017
Last Updated: 09/22/2017
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Potentially life-threatening emergency
Tension pneumothorax in Adult
Print 3 Images
View all Images (3)
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Tension pneumothorax (Awake) : Agitation, Hypoxemia, Pleuritic chest pain, Tachycardia, Dyspnea, Tachypnea
Copyright © 2019 VisualDx®. All rights reserved.