• Tension pneumothorax
• pleural disease

The problem with the recent case report ‘Tension pneumothorax mimicking giant emphysematous bullae’1 is that the patient clearly did not have a tension pneumothorax. He was not particularly unwell and had only a minimal mediastinal shift. A much greater mediastinal shift can be seen in non-tension pneumothorax.2 The actual definition of tension pneumothorax is not generally agreed. The 2003 British Thoracic Society guidelines3 refer to tension pneumothorax …