What is the difference between a simple pneumothorax (collapsed lung) and a tension pneumothorax (tension collapsed lung)?

From the Guidelines

A tension pneumothorax is a life-threatening medical emergency that requires immediate intervention, whereas a simple pneumothorax is generally not immediately life-threatening and may be managed more conservatively. The key difference between the two conditions lies in the buildup of pressure in the pleural space. In a simple pneumothorax, air enters the pleural space, causing partial lung collapse, but the pressure does not continue to build, and the patient may experience chest pain and shortness of breath, but is generally stable 1. In contrast, a tension pneumothorax occurs when air enters the pleural space but cannot escape, creating a one-way valve effect that progressively increases pressure in the chest cavity, leading to rapidly worsening respiratory distress, decreased blood pressure, and can quickly progress to cardiovascular collapse and death if not treated promptly 1.

Some key characteristics of a tension pneumothorax include:

• Rapid deterioration in cardiopulmonary status
• Impaired venous return, reduced cardiac output, and hypoxaemia
• Rapid laboured respiration, cyanosis, sweating, and tachycardia
• Development of tension is not dependent on the size of the pneumothorax
• Clinical scenario may correlate poorly with chest radiographic findings

Treatment for a tension pneumothorax requires immediate needle decompression followed by chest tube placement, as recommended by guidelines such as the BTS guidelines for the management of spontaneous pneumothorax 1. The use of a cannula of adequate length, at least 4.5 cm, is recommended to ensure proper function of the intercostal tube 1. In contrast, a simple pneumothorax may be managed more conservatively, depending on its size and the patient's symptoms. Prompt recognition and treatment of a tension pneumothorax are critical to preventing morbidity and mortality, and healthcare providers should be vigilant for signs of tension pneumothorax, particularly in patients on mechanical ventilators or nasal non-invasive ventilation who suddenly deteriorate or develop cardiac arrest 1.

From the Research

Difference between Simple Pneumothorax and Tension Pneumothorax

• A simple pneumothorax, also known as a collapsed lung, occurs when air enters the space between the lung and chest wall, causing the lung to collapse partially or completely 2.
• A tension pneumothorax, on the other hand, is a life-threatening condition that occurs when air enters the space between the lung and chest wall and becomes trapped, causing the lung to collapse completely and putting pressure on the heart and other vital organs 3, 4.

Key Characteristics

• Simple pneumothorax:
  • May cause symptoms such as chest pain and shortness of breath
  • Can be treated with simple aspiration or chest tube drainage 2
  • Has a lower risk of complications compared to tension pneumothorax
• Tension pneumothorax:
  • Requires immediate medical attention
  • Can cause severe symptoms such as severe chest pain, shortness of breath, and hypotension
  • Requires emergency decompression of the chest to relieve pressure on the heart and lungs 3, 4, 5, 6

Treatment Options

• Simple pneumothorax:
  • Simple aspiration: a minimally invasive procedure where a needle is inserted into the chest to remove air from the space between the lung and chest wall 2
  • Chest tube drainage: a procedure where a tube is inserted into the chest to remove air and fluid from the space between the lung and chest wall 2
• Tension pneumothorax:
  • Needle decompression: an emergency procedure where a needle is inserted into the chest to relieve pressure on the heart and lungs 3, 4, 5, 6
  • Chest tube insertion: a procedure where a tube is inserted into the chest to remove air and fluid from the space between the lung and chest wall 3, 4, 5, 6