Which respiratory findings suggest pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

History and physical examination remain the keys to making the diagnosis of pneumothorax. Examination of patients with this condition may reveal diaphoresis and cyanosis (in the case of tension pneumothorax). Affected patients may also reveal altered mental status changes, including decreased alertness and/or consciousness (a rare finding).

Findings on lung auscultation vary depending on the extent of the pneumothorax. Respiratory findings may include the following:

  • Respiratory distress (considered a universal finding) or respiratory arrest
  • Tachypnea (or bradypnea as a preterminal event)
  • Asymmetric lung expansion: Mediastinal and tracheal shift to contralateral side (large tension pneumothorax)
  • Distant or absent breath sounds: Unilaterally decreased/absent lung sounds common, but decreased air entry may be absent even in advanced state of pneumothorax
  • Minimal lung sounds transmitted from unaffected hemithorax with auscultation at midaxillary line
  • Hyperresonance on percussion: Rare finding; may be absent even in an advanced state
  • Decreased tactile fremitus
  • Adventitious lung sounds: Ipsilateral crackles, wheezes

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