A Deadly Push: Tension Pneumothorax in a Healthy Adolescent Following Blunt Chest Trauma

Abstract

Background: Tension pneumothorax is a life-threatening emergency characterized by progressive accumulation of air in the pleural space, resulting in increased intrathoracic pressure, mediastinal shift, and cardiovascular compromise. Although it usually occurs after severe chest trauma or during mechanical ventilation, it may also appear following minor blunt chest injury.

Case presentation: A 15-year-old previously healthy male developed sudden dyspnea and right-sided pleuritic chest pain after a blunt chest contusion sustained while playing. On physical examination, the patient presented with tachypnea, hypotension, decreased breath sounds, and hyperresonance on the right hemithorax, accompanied by contralateral tracheal deviation. Chest radiography confirmed a right tension pneumothorax with mediastinal shift. Emergency needle decompression was performed, followed by chest tube insertion, leading to rapid hemodynamic stabilization and complete pulmonary re-expansion.

Conclusion: Tension pneumothorax should be considered in any patient presenting with acute respiratory distress and hemodynamic instability after blunt thoracic trauma, regardless of its apparent mildness. Immediate recognition and decompression are essential to prevent fatal outcomes.