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Tension Pneumothorax

By Thomas G. Weiser, MD, MPH, Associate Professor, Department of Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine

Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart.

  • Symptoms include chest pain, shortness of breath, rapid breathing, and a racing heart, followed by shock.

  • Doctors can usually diagnose the injury based on the person's history, symptoms, and examination results.

  • Doctors immediately insert a large needle into the chest to remove the air.

In an ordinary pneumothorax, injury to a lung allows a certain amount of air to enter the space between the lung and the chest wall (pleural space). Typically, the air stops accumulating. However, in tension pneumothorax, air continues to enter the pleural space as the person breathes and pressure rises inside the chest. The rise in pressure reduces the amount of blood returning from the body to the heart because the blood cannot force its way into the chest and back to the heart. As a result, the heart has less blood to pump to the body, resulting in shock. These effects can occur rapidly, particularly in people using a mechanical ventilator. Tension pneumothorax can rapidly be fatal.


At first, people have chest pain, feel short of breath, breathe rapidly, and feel that their heart is racing. As the pressure inside the chest increases, blood pressure drops, people feel weak and dizzy, and the veins of the neck may bulge.


  • A doctor's evaluation

Doctors diagnose tension pneumothorax based on the person's history, symptoms, and examination results. For example, one side of the chest may bulge (be distended), and doctors may hear a hollow sound when they tap it. When they listen to the chest with a stethoscope, they may not hear any air flowing to the lung.

Because tension pneumothorax is an emergency, doctors begin treatment immediately rather than doing tests.


  • Needle decompression

Doctors immediately insert a large needle into the pleural space to remove the air (called needle decompression). Then a chest (thoracostomy) tube is inserted to continue to drain air and allow the lung to reinflate (see Chest Tube Insertion). Usually local anesthesia is used.