Which sign may be present in tension pneumothorax but not in simple pneumothorax, according to the described signs?

• A. Engorged jugular veins
• B. Absent breath sounds on the affected side
• C. Hyperresonant chest on the affected side
• D. Tracheal deviation toward the affected side

Answer: (A)

Engorged jugular veins come from the rise in intrathoracic pressure that occurs with a tension pneumothorax, which squeezes venous return to the heart. That backing up of blood raises central venous pressure and makes the jugular veins visibly distended. In a simple pneumothorax, the pressure isn’t high enough to cause this venous congestion, so JVD isn’t typically present. Other signs like absent breath sounds on the affected side or a hyperresonant chest can occur in either type because they reflect air in the pleural space and lung collapse rather than the hemodynamic impact. Tracheal deviation is associated with tension as the mediastinum shifts away from the affected side; a deviation toward the affected side would not fit the tension picture, so it’s not the characteristic sign described.