What is a late sign of tension pneumothorax?

A late sign of tension pneumothorax is tracheal deviation. This occurs when increased pressure within the pleural cavity pushes the trachea away from the midline. In the context of tension pneumothorax, the escalating pressure compresses lung tissue and interferes with respiratory function, leading to clinical manifestations that can become progressively serious.

Tracheal deviation is particularly critical because it indicates a significant change in the thoracic pressure dynamics. As the condition worsens and the pressure increases, it affects mediastinal structures, including the heart and major blood vessels, causing the trachea to deviate to the opposite side of the affected hemithorax. This deviation is a clear visual cue of the severe clinical state and necessitates immediate intervention.

Decreased breath sounds, tachycardia, and hypotension are symptoms that can occur with tension pneumothorax as well, but they are often seen earlier in the sequence of signs and symptoms or can occur in other conditions, making them less specific to late-stage tension pneumothorax. Tracheal deviation serves as a distinct and alarming indicator of worsening pathology requiring prompt medical attention.