All eastbound lanes of the Vietnam Veterans Parkway were shut down after the accident, WTVF-TV, Nashville, reported.
The pileup happened around 7 a.m. on a bridge past Saundersville Road, Hendersonville police said, adding at least 45 cars were involved in three separate crashes.
At least one person died and others were injured. Sumner Regional Medical Center confirmed seven patients from the wreckage, who were all being treated for minor injuries, the report said.
A school bus, a preschool bus and a tractor trailer were all involved in the crash, officials said. No students aboard the preschool bus were injured.
There was a dense fog in the area at the time, as well as reports of ice on the bridge where the crash began, WTVF reported.
The cause of the crash is under investigation.