Snapshot A 56-year-old male with a history of chronic obstructive pulmonary disease presents with pleuritic chest pain and trouble breathing. Vital signs are significant for a blood pressure of 88/54 mmHg and a pulse of 115/min. On exam, there is jugular venous distension, decreased breath sounds on the right side, with wheezes. A chest radiograph is obtained. Introduction Tension pneumothorax results from positive pressure build-up secondary to a flap valve mechanism (or one-way valve) resulting in total lung collapse login to view 2 more bullets Increased intrathoracic pressure restricts cardiac output login to view 1 more bullet ETIOLOGY Etiologies include login to view 6 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 9 more bullets IMAGING Ultrasound login to view 3 more bullets Chest radiography (CXR) login to view 4 more bullets Differential Primary spontaneous pneumothorax, secondary pneumothorax, acute asthma, inhalation of foreign object, myocardial infarction, ruptured aortic aneurysm Tracheobronchial rupture login to view 1 more bullet Treatment/Management Prevention login to view 2 more bullets Non-operative login to view 4 more bullets Operative login to view 3 more bullets Complications Shock and death if left untreated Prognosis Shock and death will result if not immediately recognized and treated