title: Tension pneumothorax, is it a really life-threatening condition?
abstract: BACKGROUND
  Tension pneumothorax is a life-threatening occurrence that is infrequently the consequence of spontaneous pneumothorax. The aim of this study was to identify the risk factors for the development of tension pneumothorax and its effect on clinical outcomes.
  
  
  METHODS
  We reviewed patients who were admitted with spontaneous pneumothorax between August 1, 2003 and December 31, 2011. Electronic medical records and the radiological findings were reviewed with chest x-ray and high-resolution computed tomography scans that were retrieved from the Picture Archiving Communication System.
  
  
  RESULTS
  Out of the 370 patients included in this study, tension pneumothorax developed in 60 (16.2%). The bullae were larger in patients with tension pneumothorax than in those without (23.8 ± 16.2 mm vs 16.1 ± 19.1 mm; P = 0.007). In addition, the incidence of tension pneumothorax increased with the lung bulla size. Fibrotic adhesion was more prevalent in the tension pneumothorax group than in that without (P = 0.000). The bullae were large in patients with fibrotic adhesion than in those without adhesion (35.0 ± 22.3 mm vs 10.4 ± 11.5 mm; P = 0.000). On multivariate analysis, the size of bullae (odds ratio (OR) = 1.03, P = 0.001) and fibrotic adhesion (OR = 10.76, P = 0.000) were risk factors of tension pneumothorax. Hospital mortality was 3.3% in the tension pneumothorax group and it was not significantly different from those patients without tension pneunothorax (P = 0.252).
  
  
  CONCLUSIONS
  Tension pneumothorax is not uncommon, but clinically fatal tension pneumothorax is extremely rare. The size of the lung bullae and fibrotic adhesion contributes to the development of tension pneumothorax.
authors.forename: Jeong Seob
authors.initials: JS
authors.lastname: Yoon
authors.forename: Si Young
authors.initials: SY
authors.lastname: Choi
authors.forename: Jong Hui
authors.initials: JH
authors.lastname: Suh
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Bae Young
authors.initials: BY
authors.lastname: Lee
authors.forename: Yong Gue
authors.initials: YG
authors.lastname: Park
authors.forename: Chi Kyung
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Incheon St, Mary's Hospital, The Catholic University of Korea, 665-8, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Republic of Korea. drcs5223@daum.net.
authors.forename: Chan Beom
authors.initials: CB
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult