Which finding is most consistent with a tension pneumothorax on physical examination?

Which finding is most consistent with a tension pneumothorax on physical examination?

• A. Tracheal deviation away from the involved side
• B. Increased breath sounds on the affected side
• C. Elevated fremitus on the affected side
• D. Normal chest examination

Answer: (A)

In tension pneumothorax, air accumulates under pressure in the pleural space and cannot escape, rapidly compressing the lung and shifting the mediastinal structures away from the affected side. That pressure causes the trachea to deviate to the opposite side, which is the most characteristic physical examination finding. Breath sounds on the affected side would be decreased or absent rather than increased, due to collapse of the lung from the air in the pleural space. Fremitus would be reduced or absent because the air disrupts the transmission of vibrations. A normal chest examination would not reflect the dangerous physiology of a tension pneumothorax, which typically presents with tracheal shift, distended neck veins, hypotension, and unilateral decreased breath sounds.

In tension pneumothorax, air accumulates under pressure in the pleural space and cannot escape, rapidly compressing the lung and shifting the mediastinal structures away from the affected side. That pressure causes the trachea to deviate to the opposite side, which is the most characteristic physical examination finding.

Breath sounds on the affected side would be decreased or absent rather than increased, due to collapse of the lung from the air in the pleural space. Fremitus would be reduced or absent because the air disrupts the transmission of vibrations. A normal chest examination would not reflect the dangerous physiology of a tension pneumothorax, which typically presents with tracheal shift, distended neck veins, hypotension, and unilateral decreased breath sounds.