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in tension pneumothorax, regardless of phase of breating, inspiration or expiration, the pressure in the venous return, hense filling pressure to the right ventricle remains unchanged

in tamponade, right ventricular filling increases during the inspiration phase of the breathing cycle, as there is less pressure applied to the surface of the heart, hense the diastolic expansion of the right vetricle is less restricted since the negative intrathoracic pressure, required for inspiration allows this expansion, hence filling on the RV, hense, less blood pressure in the jugular vein, hense less distention of the jugular vein. so... if you see fluctuating jugular vein distention by breathing cycle in a way that it flattens during inspiration, you are dealing with cardiac tamponade. only if there is no concomitant parrallel process of hypovolemia to cause decrease in blood volume , hense little to no jugulat vein distention.

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