Which description identifies tension pneumothorax?

• A. Pleuritic chest pain, dyspnea, respiratory distress, decreased breath sounds on affected side, displaced PMI, tracheal deviation, JVD
• B. Simple chest pain without respiratory symptoms
• C. Hypotension unrelated to respiratory distress
• D. Fever and productive cough

Answer: (A)

Tension pneumothorax is an emergency where air trapped in the pleural space under pressure collapses the lung and shifts the mediastinum, compromising both lungs and venous return. The description that includes pleuritic chest pain, dyspnea with respiratory distress, decreased breath sounds on the affected side, tracheal deviation, and a displaced point of maximal impulse (PMI) fits this pattern. The mediastinal shift explains the tracheal deviation and the elevated neck veins (JVD) from reduced venous return. The PMI displacement reflects how the heart is pushed away by the shifting mediastinum.

In contrast, simple chest pain without respiratory symptoms wouldn’t show unilateral breath sound loss, mediastinal shift, or JVD. Hypotension without respiratory distress could be due to various non-pulmonary causes, not the acute pressure effect on the chest. Fever with productive cough points to infection rather than a pressure pneumothorax.