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. 2013 Oct 15:8:197.
doi: 10.1186/1749-8090-8-197.

Tension pneumothorax, is it a really life-threatening condition?

Jeong Seob Yoon, Si Young Choi, Jong Hui Suh, Jin Yong Jeong, Bae Young Lee, Yong Gue Park, Chi Kyung Kim, Chan Beom Park  1
Affiliations

Tension pneumothorax, is it a really life-threatening condition?

Jeong Seob Yoon et al. J Cardiothorac Surg. .

Abstract

Background: Tension pneumothorax is a life-threatening occurrence that is infrequently the consequence of spontaneous pneumothorax. The aim of this study was to identify the risk factors for the development of tension pneumothorax and its effect on clinical outcomes.

Methods: We reviewed patients who were admitted with spontaneous pneumothorax between August 1, 2003 and December 31, 2011. Electronic medical records and the radiological findings were reviewed with chest x-ray and high-resolution computed tomography scans that were retrieved from the Picture Archiving Communication System.

Results: Out of the 370 patients included in this study, tension pneumothorax developed in 60 (16.2%). The bullae were larger in patients with tension pneumothorax than in those without (23.8 ± 16.2 mm vs 16.1 ± 19.1 mm; P = 0.007). In addition, the incidence of tension pneumothorax increased with the lung bulla size. Fibrotic adhesion was more prevalent in the tension pneumothorax group than in that without (P = 0.000). The bullae were large in patients with fibrotic adhesion than in those without adhesion (35.0 ± 22.3 mm vs 10.4 ± 11.5 mm; P = 0.000). On multivariate analysis, the size of bullae (odds ratio (OR) = 1.03, P = 0.001) and fibrotic adhesion (OR = 10.76, P = 0.000) were risk factors of tension pneumothorax. Hospital mortality was 3.3% in the tension pneumothorax group and it was not significantly different from those patients without tension pneunothorax (P = 0.252).

Conclusions: Tension pneumothorax is not uncommon, but clinically fatal tension pneumothorax is extremely rare. The size of the lung bullae and fibrotic adhesion contributes to the development of tension pneumothorax.

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Figures

Figure 1
Figure 1
The incidence of tension pneumothorax increases with the size of the largest bullae.
Figure 2
Figure 2
Comparison of bulla size relative to the presence of tension pneumothorax. Among patients without fibrotic adhesion, the bullae were larger in the tension pneumothorax group than in those without tension pneumothorax (15.2 ± 12.7 mm vs 9.8 ± 11.2 mm, P = 0.025). However, in cases where fibrotic adhesion was present, the size of the bullae did not differ significantly between the groups (32.0 ± 15.1 mm vs 36.3 ± 24.8 mm; P = 0.323). ns, not statistically significant; * P 0.05.
See this image and copyright information in PMC

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