Which finding suggests a tension pneumothorax?

Which finding suggests a tension pneumothorax?

• A. Tracheal deviation toward the injured side with hyperresonance
• B. Normal breath sounds
• C. JVD and tracheal deviation away from the injured lung
• D. Decreased fremitus with dullness

Answer: (C)

Mediastinal shift with venous congestion is the key clue for a tension pneumothorax. When air enters the pleural space and cannot escape, intrapleural pressure rises rapidly. This not only collapses the affected lung but also pushes the mediastinum, including the trachea, away from the side with the injury. The increased pressure also impairs venous return to the heart, causing jugular venous distension. Taken together, jugular venous distension plus tracheal deviation away from the injured side are classic, high‑impact signs of a tension pneumothorax and indicate an emergency that requires immediate decompression. The other findings don’t fit tension pneumothorax. Tracheal deviation toward the injured side would suggest a large pneumothorax without the same level of mediastinal shift and may imply a different scenario. Normal breath sounds don’t reflect the collapsed lung and air in the pleural space, and dullness with decreased fremitus points toward effusion or consolidation rather than a pneumothorax with tension.

Mediastinal shift with venous congestion is the key clue for a tension pneumothorax. When air enters the pleural space and cannot escape, intrapleural pressure rises rapidly. This not only collapses the affected lung but also pushes the mediastinum, including the trachea, away from the side with the injury. The increased pressure also impairs venous return to the heart, causing jugular venous distension. Taken together, jugular venous distension plus tracheal deviation away from the injured side are classic, high‑impact signs of a tension pneumothorax and indicate an emergency that requires immediate decompression.

The other findings don’t fit tension pneumothorax. Tracheal deviation toward the injured side would suggest a large pneumothorax without the same level of mediastinal shift and may imply a different scenario. Normal breath sounds don’t reflect the collapsed lung and air in the pleural space, and dullness with decreased fremitus points toward effusion or consolidation rather than a pneumothorax with tension.