Malignant Tension Hydrothorax with Mediastinal Shifting: Emergency Decompression of a Rare and Potentially Lethal Respiratory Condition

Introduction: A Tension Hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients the pleural volume increases the intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may lead to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. Case presentation: We present a two-case report of patients presenting with a malignant tension hydrothorax managed in the emergency room with ultrasound-guided decompression thoracentesis and the other patient with tube thoracostomy. Conclusion: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions and pathologies such as a Tension hydrothorax which continues to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.