tension pneumothorax


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Related to tension pneumothorax: flail chest, open pneumothorax

ten·sion pneu·mo·thor·ax

a pneumothorax in which air enters the pleural cavity and is trapped during expiration; intrathoracic pressure builds to levels higher than atmospheric pressure, compresses the lung, and may displace the mediastinum and its structures toward the opposite side, with consequent cardiopulmonary impairment.

tension pneumothorax

Etymology: L, tendere, to stretch; Gk, pneuma, air, thorax
the presence of air in the pleural space when pleural pressure exceeds alveolar pressure, caused by a rupture through the chest wall or lung parenchyma associated with the valvular opening. Air passes through the valve during coughing but cannot escape on exhalation. Unrelieved pneumothorax can lead to respiratory arrest.

tension pneumothorax

A life-threatening emergency caused by air under pressure in the pleural space due to a one-way valve mechanism, which allows increased entry of air and eventually complete lung collapse on the affected side, accompanied by mediastinal shift of thoracic organs (heart, trachea, oesophagus) and great vessels towards the unaffected side of the chest, and compression of the opposite lung with compromise in the return flow of blood to the heart.
 
Aetiology
Penetrating trauma to the chest, infection, mechanical ventilation with high pressures, and as a complication of CPR.
 
Management
Chest tube drainage, or pleurodesis.

tension pneumothorax

Critical care A life-threatening emergency consisting of air under pressure in the pleural space, due to a one-way valve type mechanism, allowing ↑ entry of air and eventually complete lung collapse on the affected side, which is acompanied by mediastinal shift of thoracic organs–heart, trachea, esophagus, and great vessels towards the unaffected side of the chest, and compression of the opposite lung with compromise in the return flow of blood to the heart Etiology Penetrating trauma to the chest, infection, mechanical ventilation with high pressures, and as a complication of CPR Management Chest tube drainage, or pleurodesis. See Pneumothorax.

pneumothorax

entry of air into the pleural cavity in sufficient quantity to cause collapse of the lung and consequent respiratory embarrassment. If it is unilateral there is a mediastinal shift with displacement of the heart to the other side of the chest. Breath sounds are absent from the affected side.
Enlarge picture
Pneumothorax. By permission from Ettinger SJ, Feldman E, Textbook of Veterinary Internal Medicine, Saunders, 2004

closed pneumothorax
air leaks from a discontinuity in the lung into the pleural cavity.
false pneumothorax
artifactual increased radiolucency of the thorax resembling free air in the pleural cavity.
iatrogenic pneumothorax
may occur following intrathoracic surgery or in association with procedures which involve entry into the pleural cavity, such as thoracentesis or placement of a chest drain.
open pneumothorax
caused by an open wound in the chest wall.
spontaneous pneumothorax
due to an unknown cause.
tension pneumothorax
a particularly dangerous form of pneumothorax that occurs when air escapes into the pleural cavity from a bronchus but cannot regain entry into the bronchus. As a result, continuously increasing air pressure in the pleural cavity causes progressive collapse of the lung tissue. If not relieved, it can lead to lung collapse and mediastinal shift.
References in periodicals archive ?
Tension pneumothorax is a rare presentation of intestinal perforation, and there are only a handful of reports of such cases in the literature, all of which are a complication of endoscopic intervention (2,3).
Classical chest X-ray signs for a tension pneumothorax include a visible lung edge running parallel to the chest wall, hyperlucency, deep sulcus sign and abdominal quadrant hyperlucency.
The treatment of a tension pneumothorax on the battlefield involves needle decompression by placing a hollow needle through the second intercostals space in the midclavicular line.
The clinical presentation of a tension pneumothorax is often similar with severe cardio-respiratory compromise and the patient in extremis.
A low-dose X-ray (LODOX) Statscan performed at the Tygerberg Forensic Pathology Laboratory demonstrated a left-sided tension pneumothorax, right shift of the mediastinum, depression of the left hemi-diaphragm, and collapse of the left lung, all of which were confirmed at autopsy (Fig.
Hydatid cyst rupture can also present as tension pneumothorax (8).
Prevalence of tension pneumothorax in fatally wounded combat casualties.
If a tension pneumothorax is detected then emergent drainage is required.
Certainly thrombolytic therapy would be contraindicated in patients with refractory cardiac arrest due to toxic-metabolic causes, hypovolemia, tension pneumothorax, or cardiac tamponade.
In another case, the ICD was inserted below the left diaphragm, the acute gastrothorax following blunt chest trauma having being misdiagnosed as a tension pneumothorax (Table III) (Figs 2 and 3).
The first description was cited as "subcutaneous emphysema and thoracic inflation" (2) but most of the cases developed a tension pneumothorax, sometimes bilateral (4,5).
We also reviewed again and again various battlefield procedures such as needle decompression of tension pneumothorax, nasopharyngeal airway insertion, and cricothyrotomy.