clinical features

Last reviewed 08/2021

Patients with pneumothorax may be asymptomatic or may present typically with abrupt onset of pleuritic type chest pain and breathlessness.

• these typical symptoms of chest pain and dyspnoea may be relatively minor or even absent in some patients initially (especially in primary pneumothorax where the patient presents several days after the onset of symptoms), hence a high index of initial diagnostic suspicion is required
• patients with secondary pneumothorax usually complain of additional symptoms due to coexistent lung disease
• in general, the clinical symptoms associated with secondary spontaneous pneumothorax (SSP) are more severe than those associated with primary spontaneous pneumothorax and most patients with SSP experience breathlessness that is out of proportion to the size of the pneumothorax

The physical signs of a pneumothorax can be subtle but, characteristically include:

• reduction in lung expansion of the affected side
• a hyper-resonant percussion note
• diminished breath sounds on the affected side
• added sounds such as “clicking” sound can be heard in time with the heart beat - in a left sided pneumothorax (2)

A small pneumothorax may present without any clinical features but, often, may be seen on chest x-ray as a small crescentic line running parallel to the chest wall, outside of which no lung markings are visible.

Note:

• when severe symptoms are accompanied by signs of cardiorespiratory distress (cyanosis, sweating, severe tachypnoea, tachycardia and hypotension), tension pneumothorax must be considered (1)

Reference:

• (1) Bintcliffe O, Maskell N. Spontaneous pneumothorax. BMJ. 2014;348:g2928
• (2) MacDuff A et al. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii18-31