Spontaneous vs Tension Pneumothorax

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SPONTANEOUS:

Primary: no preceding event or lung dz; thin, young men
Secondary: underlying lung dz, eg COPD

Chest pain, dyspnea
Decreased breath sounds and chest movement
Ipsilateral hyperresonance to percussion

CXR: absent lung markings, visceral pleural line

Treatment:
Small (2cm or less): observe, oxygen
Large and stable: needle aspiration or chest tube

TENSION:
Life threatening
Often due to trauma or mechanical ventilation

Same as spontaneous, + hemodynamic instability, + tracheal deviation away from the affected side

CXR: same, + contralateral mediastinal shift; ipsilateral hemidiaphragm flattening

Treatment:
Urgent needle decompression or chest tube placement