Pneumothorax clinical manifestations

Written by Yuan Qing
Pulmonology
Updated on April 01, 2025
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Pneumothorax is primarily caused by various factors, both internal and external to the lungs, leading to a significant accumulation of gas within the chest cavity. Patients exhibit symptoms such as chest tightness, breathlessness, including coughing, chest pain, and other related symptoms, which are collectively referred to as pneumothorax. Patients with pneumothorax can be classified into mild and severe types. Generally, after the onset of pneumothorax, patients who only experience symptoms like panting, chest tightness, chest pain, or coughing, but maintain stable blood pressure and heart rate, are considered to have a mild condition. However, if in addition to these respiratory symptoms, the patient clearly exhibits a drop in blood pressure, a decrease in oxygen saturation, or a reduction in heart rate, these conditions are considered severe and require urgent treatment.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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The difference between tension pneumothorax and open pneumothorax.

The main difference between a tension pneumothorax and an open pneumothorax lies in the relative pressures of the pleural cavity compared to the atmospheric pressure. An open pneumothorax occurs when the pleural cavity is in an open state due to some reason. During inhalation, gas can enter the pleural cavity, and during exhalation, the gas can be expelled through this opening or another opening, resulting in pleural cavity pressure that is roughly equal to the atmospheric pressure. In a tension pneumothorax, due to some reason, a one-way valve is formed. The gas enters the pleural cavity easily but encounters resistance during expulsion, causing the pressure in the patient's pleural cavity to increase progressively. The gas can only enter the pleural cavity and cannot be effectively expelled. Therefore, the main difference between a tension pneumothorax and an open pneumothorax is the level of pleural cavity pressure compared to atmospheric pressure; in a tension pneumothorax, the pressure in the pleural cavity is significantly higher than the atmospheric pressure, while in an open pneumothorax, the pressures are roughly equal.

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Written by Han Shun Li
Pulmonology
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Are the symptoms of pneumothorax severe?

Pneumothorax is caused by a rupture of the pleura, allowing air to enter the pleural cavity. The severity of symptoms after suffering from pneumothorax can vary, with common symptoms including coughing, chest pain, chest tightness, and difficulty breathing. The severity of symptoms largely depends on the amount of air in the pleural space. If the amount of air is small, symptoms might not be noticeable. However, with a larger amount of air, difficulty breathing can be quite severe. In cases of tension pneumothorax, the symptoms can be extremely severe and may even lead to respiratory and circulatory failure in a short period. Patients often experience significant chest tightness, restlessness, dry skin, heavy sweating, and may even lose consciousness. Immediate treatment is necessary, as there could be a risk to life.

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Written by Li Tao
Pulmonology
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What are the symptoms of pneumothorax?

Pneumothorax refers to the accumulation of air that occurs when air enters the pleural cavity, a closed space, which is known as pneumothorax. The most common clinical manifestations of pneumothorax depend on the speed of onset, the degree of lung compression, and the etiology of the primary disease causing the pneumothorax. Typically, patients may experience a high level of mental tension, fear, restlessness, shortness of breath, and a feeling of suffocation. Some individuals may sweat, have an increased pulse rate, with the most prominent symptom being difficulty in breathing. Additionally, some patients may experience coughing and chest pain, and some may develop mediastinal emphysema, leading to gradually worsening respiratory difficulties, and even manifestations of shock such as a drop in blood pressure.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to check for hemothorax and pneumothorax?

Actually, the examination methods for hemothorax and pneumothorax are quite simple. From their definitions, we know that hemothorax means the abnormal presence of blood in the pleural cavity, and pneumothorax means the presence of gas in the pleural cavity where it shouldn't be. Therefore, the simplest examination is an X-ray, a standard frontal and lateral chest X-ray, which usually costs about 52 yuan, can detect whether a patient has pneumothorax. As for hemothorax, of course, it involves the use of a syringe. After injecting some lidocaine local anesthesia into the patient, if blood is withdrawn from the pleural cavity, then it indicates a hemothorax. Thus, the first step in examining for hemothorax and pneumothorax is to perform an X-ray to check for the presence of gas. If gas is detected, then it is pneumothorax. If liquid is found, a syringe under ultrasound guidance can be used to withdraw it. If the withdrawal yields fluid, it indicates pleural effusion; if blood is drawn, then it indicates hemothorax.

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What position should be taken for pneumothorax?

Pneumothorax occurs when the pleura ruptures and gas enters the pleural cavity, often compressing the lung tissue. Patients may experience symptoms such as chest pain, chest tightness, and coughing. The choice of lying position for patients with pneumothorax depends on the severity of the pneumothorax and the degree of chest tightness. If the pneumothorax is mild and the symptoms are not obvious, the patient can lie flat. If there is significant chest tightness, a semi-recumbent position may be adopted. If the chest tightness is severe and the patient has significant difficulty breathing, they often assume a sitting position, frequently struggling to breathe, sweating profusely, and may even experience respiratory failure, requiring immediate attention.