Is Radiological Reporting of 'Tension' in Spontaneous Pneumothorax Driving Unnecessary Intervention?

Decompensated (aka tension) primary spontaneous pneumothorax (PSP) is extremely rare. There is no published evidence that conservative treatment of stable patients with radiological features of so-called 'tension' (e.g., tracheal deviation and mediastinal shift) results in adverse outcomes. There is also preliminary evidence that these features do not correlate with significant clinical instability. However, anecdotally, clinicians report being uncomfortable not providing interventional treatment for stable PSP patients with radiological features of tension, in part for fear of litigation. This article addresses current evidence and guidelines and the likely medicolegal implications of treatment options for clinically stable PSP patients with these radiological features.