Spontaneous tension pneumothorax: a devastating consequence of pulmonary tuberculosis

Tuberculosis (TB) was the world’s second leading cause of death from a single infectious agent, with mortality reaching 50% in untreated cases. It has been acknowledged as a potential cause of secondary spontaneous pneumothorax. A 57-year-old male presented to emergency department due to shortness of breath since 12 hours before admission. He had a history of chronic cough along with significant weight loss. He was cachexic and fully alert, with normal blood pressure, tachypnea, and slight tachycardia. Decreased breath sounds on the right hemithorax was noted. Chest x-ray revealed right tension pneumothorax and active pulmonary TB. Emergency needle decompression was performed with 14-gauge intravenous catheter. Unfortunately, he died eight hours later following a cardiac arrest. Occurrence of spontaneous tension pneumothorax in TB involves several mechanisms such as pleural porosity, chronic inflammation, and alveolar rupture. Compensatory mechanisms including gradual tachycardia, respiratory rate elevation, along with increasingly negative contralateral intrathoracic pressures could preserve venous return, serving as protective factors against hypotension until the late stages. Late presentation of 12 hours after the first onset might contribute to enormous air leak that could not be effectively managed by needle decompression. Undiagnosed and untreated TB could lead to morbid consequence such as tension pneumothorax, highlighting the importance of TB detection within the community. Clinicians should be aware of variations in the clinical presentation of tension pneumothorax as compensatory mechanisms may hinder the diagnosis at initial presentation. Strategic approaches are imperative to reinforce our commitment to eliminate TB by 2030.