Clinical features of pneumothorax

Clinical features
Symptoms:
There may be no symptoms (especially in fit young people with small pneumothoraces) or there may be sudden onset of dyspnoea and/or pleuritic chest pain.
Patients with asthma or COPD may present with a sudden deterioration.
Mechanically ventilated patients may present with hypoxia or an increase in ventilation pressures.

Signs:
reduced expansion,
hyper-resonance to percussion and diminished breath sounds on the affected side.
With a tension pneumothorax, the trachea will be deviated away from the affected side and the patient will be very unwell.

Investigations
CXR should not be performed if a tension pneumothorax is suspected, as it will delay immediate necessary treatment.
Otherwise, request an expiratory film, and look for an area devoid of lung markings, peripheral to the edge of the collapsed lung.
Ensure the suspected pneumothorax is not a large emphysematous bulla.
Check ABG in dyspnoeic patients and those with chronic lung disease.