Symptoms of pneumothorax

We all know that the internal organs of the human body are interconnected, so many times when one organ has problems, it is likely to cause other organs to become sick as well. For example, pneumothorax is a disease in which not only the lung organs are malfunctioning, but the chest organs are also damaged. Patients with pneumothorax will feel extreme difficulty when breathing, and often feel chest tightness and shortness of breath. So what are the clinical symptoms of pneumothorax?

1. Clinical manifestations

1. Symptoms The severity of pneumothorax symptoms depends on the onset, degree of lung compression and the condition of the primary lung disease. Typical symptoms are sudden chest pain, followed by chest tightness and difficulty breathing, and may be accompanied by an irritating cough. This chest pain is often stabbing or cutting and lasts for a short time. Irritating dry cough is caused by gas irritating the pleura. Most patients have an acute onset, large pneumothorax, or those with pre-existing lung lesions, in which case shortness of breath is obvious. Some patients experience triggers such as severe coughing, holding their breath while defecating or lifting heavy objects before pneumothorax occurs, but many patients develop the disease during normal activities or quiet rest. Moderate pneumothorax in young healthy people rarely causes discomfort, and sometimes the patient is only discovered during physical examination or routine chest fluoroscopy; however, elderly people with emphysema may experience obvious dyspnea even if the lung is compressed by less than 10%.

Patients with tension pneumothorax often show extreme mental tension, fear, irritability, shortness of breath, a feeling of suffocation, cyanosis, sweating, and have a weak and rapid pulse, a drop in blood pressure, cold and wet skin and other shock states, and even unconsciousness and coma. If not rescued in time, it often leads to death.

Patients with pneumothorax generally do not have fever, elevated white blood cell count or increased erythrocyte sedimentation rate. If these manifestations occur, it often indicates that the original lung infection (tuberculous or purulent) is active or complications (such as exudative pleurisy or empyema) have occurred.

A small number of patients may develop bilateral pneumothorax, the incidence of which accounts for 2% to 9.2% of spontaneous pneumothorax, or even up to 20%. For those over 20 years old, the male to female ratio is 3:1. The most prominent symptom is dyspnea, followed by chest pain and cough. It was also found that the incidence of bilateral metachronous spontaneous pneumothorax (i.e. pneumothorax that occurs first on one side and then on both sides) was relatively higher than that of bilateral simultaneous spontaneous pneumothorax, reaching 83.9%.

Some patients with pneumothorax also have mediastinal emphysema, which makes breathing more severe and often causes obvious cyanosis. Even more rarely, pneumothorax occurs when pleural adhesions or pleural blood vessels are torn, resulting in hemothorax. If the amount of bleeding is large, it may manifest as signs of shock such as pale complexion, cold sweat, weak pulse, and decreased blood pressure. But most patients only have minor bleeding.

When an asthma patient is in state of asthma persistence and his condition continues to worsen despite active treatment, it should be considered whether he has developed pneumothorax. Conversely, patients with pneumothorax sometimes present with asthma-like symptoms, severe shortness of breath, and even wheezing in both lungs. Once the pleural cavity is decompressed, the shortness of breath and wheezing will disappear.

2. Physical signs depend on the amount of gas accumulation and whether there is pleural effusion. When there is a small amount of pneumothorax, the physical signs are not obvious, especially in patients with emphysema, the percussion response is also enhanced, making it difficult to determine pneumothorax, but auscultation of weakened breath sounds is of great significance. In patients with emphysema and pneumothorax, although the breath sounds are weakened on both sides, the weakening is more obvious on the side with pneumothorax than on the contralateral side, and this change occurs even if the amount of pneumothorax is not large. Therefore, it is very important to carefully compare the breath sounds on both sides clinically, and auscultation is more sensitive than percussion. Therefore, percussion and auscultation should be used in combination, and special attention should be paid to subtle changes in the contrast between the two sides and between the upper and lower parts.

If the pneumothorax volume is more than 30%, the chest cavity on the affected side is full, the intercostal space is bulging, the respiratory movement is weakened, percussion is tympanic, and the heart or liver dullness area disappears. Voice tremor and breath sounds are weakened or disappeared. In case of massive pneumothorax, the trachea and mediastinum may shift to the healthy side. Tension pneumothorax may be seen as bulging chest and increased blood pressure on the affected side (which may be related to severe hypoxia, as blood pressure quickly returns to normal after venting).

In case of a small amount of pneumothorax on the left side, a special cracking sound can sometimes be heard at the left cardiac border. When it is obvious, the patient can also perceive it himself, which is called Hamman's sign. The crackles are in sync with the heartbeat and are more audible when the patient exhales while lying on the left side. This type of "sounding" pneumothorax is often a small pneumothorax. Other common signs are difficult to detect clinically, so it is one of the bases for diagnosing a small left-sided pneumothorax. The mechanism of this sound may be caused by the sudden movement of gas when the heart contracts, and the sudden contact and separation of the two layers of pleura. This sign is also an important sign for diagnosing mediastinal emphysema.

A small amount of pleural effusion is often due to exudate produced by air irritating the pleura, but it may also be due to pneumothorax causing pleural tearing and hemothorax. Small amounts of effusion are difficult to detect during a physical examination and can only be detected through a chest X-ray. If pneumothorax is accompanied by a large amount of fluid effusion, signs of both air and fluid accumulation can be found in the chest, and shaking the chest may produce a splashing sound.

Clinical manifestations of traumatic pneumothorax: In addition to a history of chest trauma, symptoms and signs of trauma, the main manifestations are sudden chest pain, dyspnea, and occasionally a small amount of hemoptysis. Physical and X-ray findings of pneumothorax then appeared. If hemothorax occurs, there will be symptoms of pleural effusion and internal bleeding.