What are the symptoms of a pneumothorax?

Symptoms of Pneumothorax

The primary symptoms of pneumothorax include chest pain, shortness of breath (dyspnea), and diminished breath sounds on the affected side. 1

Common Symptoms

• Chest pain - Typically acute, ipsilateral (same side as pneumothorax), and may be sharp or stabbing in nature 1
• Dyspnea (shortness of breath) - Can range from mild to severe depending on the size of the pneumothorax and underlying lung function 1
• Diminished breath sounds on the affected side during auscultation 1
• Tachypnea (rapid breathing) - Especially in larger pneumothoraces or those with underlying lung disease 1
• Cough - May be present but is not a universal finding 1

Symptoms by Pneumothorax Type

Primary Spontaneous Pneumothorax

• Often presents with milder symptoms in otherwise healthy individuals 1
• May be asymptomatic if small (less than 15% of lung volume) 1
• Symptoms typically develop suddenly 1

Secondary Spontaneous Pneumothorax

• Usually presents with more severe symptoms due to underlying lung disease 1
• Even small pneumothoraces can cause significant respiratory distress 1
• Patients may experience more pronounced hypoxemia 1

Tension Pneumothorax

• Progressive dyspnea that rapidly worsens 1
• Tachycardia and hypotension 1
• Cyanosis in severe cases 1
• Mediastinal shift (detectable on examination) 1
• Distended neck veins due to impaired venous return 1
• Rapidly deteriorating cardiopulmonary status 1

Physical Examination Findings

• Decreased or absent breath sounds on the affected side 1
• Hyperresonance on percussion of the affected side 1
• Decreased chest wall movement on the affected side 1
• Tachycardia - More common in tension pneumothorax or large pneumothoraces 1
• Subcutaneous emphysema - Air in the soft tissues may be palpable in some cases 1
• Paradoxical chest wall movement - In cases with associated flail chest 1

Special Circumstances

Open Pneumothorax

• Sucking or hissing sounds from the chest wall 1
• Foamed blood in the wound 1
• Chest wall unable to rise normally during inhalation 1

Post-procedural Pneumothorax

• May develop immediately or within hours after procedures like lung biopsy 1
• Can occasionally present as delayed pneumothorax up to 24 hours after procedure 1
• Similar symptoms to spontaneous pneumothorax 1

Warning Signs of Severe Pneumothorax

• Rapidly worsening dyspnea 1
• Hemodynamic instability (hypotension, tachycardia) 1
• Oxygen desaturation despite supplemental oxygen 1
• Altered mental status 1
• Respiratory distress with accessory muscle use 1

Pitfalls in Diagnosis

• Small pneumothoraces may be asymptomatic or minimally symptomatic but can progress 1
• In supine patients, pneumothorax may accumulate inferiorly and be harder to detect clinically 1
• Symptoms may be attributed to underlying lung disease in patients with COPD or other respiratory conditions 1
• Tension pneumothorax is a clinical diagnosis that requires immediate intervention regardless of radiographic confirmation 1

Remember that breathless patients should not be left without intervention regardless of the size of the pneumothorax on a chest radiograph, as symptoms are more important than radiographic appearance in determining treatment urgency 1.