Diagnosis

A tension pneumothorax is a very rapidly progressing event in which patients can deteriorate within a very short time. Therefore a clinical diagnosis is often possible or necessary. This means that the rescue service or a physician can already suspect a tension pneumothorax on the basis of external parameters such as pulse, blood pressure, skin color, respiratory behavior and congested blood vessels. A diagnosis is usually confirmed by an X-ray of the chest (chest X-ray) or in rare cases by a CT (computed tomography).

What can you see on the X-ray?

The chest x-ray, which usually takes an image of the chest from the front as well as from the side, is the standard procedure for the diagnosis of a tension pneumothorax. A pneumothorax is represented by one or possibly two collapsed (sunken) lungs and free air, which appears very dark. A tension pneumothorax also shows a displacement of the mediastinum. This means that the heart and its incoming and outgoing blood vessels are displaced towards the healthy side. The more advanced the shift is, the more dangerous the condition is and the more urgent an intervention is needed.

Associated symptoms

Accompanying symptoms of a tension pneumothorax are mainly increasing difficulty in breathing (dyspnoea), an increased heart rate (tachycardia) and falling blood pressure (hypotension), usually accompanied by shock symptoms. Patients are also often very pale, suffer from dizziness, weakness, possible unconsciousness and signs of cyanosis. Cyanosis describes a blue discoloration of the mucous membranes as a sign of an undersupply of oxygen. Another symptom is a congestion of the blood vessels of the neck, which already indicates an advanced stage and a mediastinal shift. Depending on the cause of the tension pneumothorax, chest pain and accompanying injuries may also be present.

Crackles under the skin

Crepitatio is a medical term for a crackling or crunching sound that can occur in various situations.In tension pneumothorax, crepitation can occur in the context of a so-called skin emphysema. A skin emphysema is a superficial accumulation of air in the skin tissue. In a tension pneumothorax, this can be caused by external injury to the lungs.

The air from the lungs escapes into the skin tissue and remains there. Symptoms are the typical crepitatio, especially due to pressure on the corresponding areas, protrusions and the displaceability of the respective protrusions. Skin emphysema is diagnosed by an X-ray thorax.