True or false: A simple pneumothorax can progress to a tension pneumothorax?

• A. True
• B. False
• C. Not sure
• D. Not applicable

Answer: (A)

A pneumothorax can worsen into a tension pneumothorax when air continues to enter the pleural space but cannot escape. This creates increasing intrapleural pressure with each breath, which collapses the affected lung and pushes the mediastinum toward the opposite side. That shift compresses the heart and great vessels, reducing venous return and causing rapid deterioration in circulation. Because this progression is possible, the statement is true. In practice, any patient with a pneumothorax who develops worsening shortness of breath, chest pain, hypoxia, or signs of hemodynamic instability should be treated as evolving tension pneumothorax and managed urgently with decompression.