Very common presentations are sudden chest pain and shortness of breath. The pain is often said to be stabbing, radiates to the ipsilateral shoulder and is worse on inspiration. In primary spontaneous pneumothorax, there is usually resolution in the first 24 hours although it might take up to 12 weeks to resolve. Other symptoms of pneumothorax are cough, anxiety and general feeling of malaise. Hypoxia and hypotension are characteristic of tension pneumothorax.

Physical signs include respiratory distress, tachypnea, absent breath sounds, decreased tactile fremitus, tachycardia, hypotension, pulsus paradoxus and jugular venous distension [7].

• Tall Stature

  […] pressures within the chest and cardiorespiratory compromise References:[1] Etiology Spontaneous pneumothorax Primary (idiopathic or simple pneumothorax) Ruptured subpleural apical blebs Risk factors Family history Male gender Asthenic body habitus (slim, tall [amboss.com]

  Tall stature and low body mass index are also associated with higher rates of PSP. It is hypothesised that the RB develops in smokers and leads to the development of ELC in patients predisposed to this process. [web.archive.org]

• Acutely Ill Patient

  Contraindications to Pneumovax and Prevnar include severe prior allergic reaction, and moderate or severe acute illness. [thelamfoundation.org]

• Dyspnea

  Presentation is variable and may range from no symptoms to severe dyspnea with tachycardia and hypotension. [radiopaedia.org]

  We present a case of trapped lung caused by a pneumothorax that occurred some 14 years before the patient presented to our hospital with a complaint of incapacitating dyspnea. [ncbi.nlm.nih.gov]

  Spontaneous pneumothorax may be treated conservatively with bedrest if there is no sign of increased pleural pressure, less than 15% lung collapse, no dyspnea or other indication of physiological compromise. [medical-dictionary.thefreedictionary.com]

  Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side. [amboss.com]

• Tracheal Deviation

  Note the tracheal deviation to the left. Prognosis If the pneumothorax was an isolated event and treatment was initiated early, the prognosis is excellent. [emedicine.medscape.com]

  In a tension pneumothorax, findings may include a displaced point of maximal impulse, tracheal deviation, mediastinal shift, and hemodynamic instability. [journals.lww.com]

  A tension pneumothorax additionally presents with distended neck veins, tracheal deviation, and hemodynamic instability. Both should be suspected on clinical evaluation. [amboss.com]

• Hyperresonance

  On lung examination, hyperresonance to percussion, decreased tactile fremitus, and diminished breath sounds are present on the affected side. [journals.lww.com]

  Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side. [amboss.com]

  […] symptoms (e.g. general malaise, fatigue) are less commonly observed Signs General appearances may be normal Sweating, tachypnoea, tachycardia (most common finding) Splinting of the chest wall to relieve pleuritic pain Decreased or absent breath sounds Hyperresonance [rch.org.au]

  […] penetrating trauma non- penetrating trauma blunt trauma is most common cause severe coughing can also cause Presentation Symptoms sudden-onset, unilateral, pleuritic chest pain dyspnea acute respiratory distress Physical exam decreased or absent breath sounds hyperresonance [step2.medbullets.com]

• Decreased Breath Sounds

  He suddenly develops increased respiratory distress, pleuritic chest pain, and decreased breath sounds in the right chest. [step2.medbullets.com]

  Tension pneumothorax will typically present with decreased or absent breath sounds on the affected side. The trachea may be deviated to the opposite side. The patient will typically be tachycardic and hypotensive. [clinicaladvisor.com]

  They include anxiety, swollen neck veins, weak pulse, and decreased breathing sounds from the lung. DIAGNOSIS Pneumothorax is diagnosed by listening to the patient's chest. [encyclopedia.com]

  It is suspected by the sudden onset, usually during activity such as vigorous coughing, vomiting, sport etc and confirmed either by physical examination (decreased respiratory incursion on one side, possibly decreased breath sounds especially at the apex [en.wikiversity.org]

• Tachypnea

  Vital signs frequently demonstrate tachycardia, tachypnea and, depending on the severity, hypoxia and hypotension. [cdemcurriculum.com]

  Tachypnea c. Decreased resonance to percussion d. [journals.lww.com]

  Physical signs include respiratory distress, tachypnea, absent breath sounds, decreased tactile fremitus, tachycardia, hypotension, pulsus paradoxus and jugular venous distension. [symptoma.com]

  Rapidly evolving hypotension, tachypnea, tachycardia and cyanosis should raise the suspicion of tension pneumothorax, which is, however, extremely rare in PSP. [err.ersjournals.com]

• Abdominal Pain

  Aggravating abdominal pain and free air on simple radiography are representative clinical manifestations of colonoscopic perforation. [ncbi.nlm.nih.gov]

  The most common include For abortive poliomyelitis fever (up to 103º F) decreased appetite nausea and/or vomiting sore throat not feeling well constipation abdominal pain For nonparalytic poliomyelitis headache, nausea and vomiting may be worse child [childrenshospital.org]

  Women with endometriosis should be asked about pleuritic, shoulder or upper abdominal pain occurring at the time of their menses, as if present they are at high risk of PSP. [patient.info]

   Manifestations:  Moderate fever  Upper respiratory manifestations: pharyngitis and sore throat  Gastrointestinal manifestations: vomiting, abdominal pain, and diarrhea. 15. Cont….. [slideshare.net]

• Chest Pain

  When to Seek Medical Care for a Collapsed Lung A doctor should be seen after any symptoms of chest pain are experienced, because of the possibility of other equally or more serious causes of chest pain. [emedicinehealth.com]

  Other signs and symptoms are a sudden sharp chest pain, fall in blood pressure, weak and rapid pulse, and cessation of normal respiratory movements on the affected side of the chest. [medical-dictionary.thefreedictionary.com]

  They range from none to a little shortness of breath or chest pain to severe shortness of breath, shock, and life-threatening cardiac arrest. Most often, sharp chest pain and shortness of breath and occasionally a dry hacking cough begin suddenly. [merckmanuals.com]

  Patients with pneumothorax often develop shortness of breath or chest pain. The diagnosis of pneumothorax is made using a chest X-ray. Chest X-ray—This is performed in radiology. [drminkim.com]

• Hypotension

  Hypoxia and hypotension are characteristic of tension pneumothorax. Physical signs include respiratory distress, tachypnea, absent breath sounds, decreased tactile fremitus, tachycardia, hypotension, pulsus paradoxus and jugular venous distension. [symptoma.com]

  Vital signs frequently demonstrate tachycardia, tachypnea and, depending on the severity, hypoxia and hypotension. [cdemcurriculum.com]

  Pleural Disease: Tension Pneumothorax Related Conditions pulseless electrical activity cardiopulmonary arrest hypotension hypoxia 1. [clinicaladvisor.com]

  Tension Pneumothorax is 2 Diseases rather than 1 Awake/Spontaneously Breathing Patients Purely hypoxemic No hypotension until just before collapse May have long periods of compensation (though can also progress in minutes) Ventilated Patients Sudden, [emcrit.org]

• Cyanosis

  Cyanosis or blueness of the skin will occur as the tissues lose their oxygen. Decreased levels of consciousness may occur because of the low blood pressure, decreased brain perfusion, and low oxygenation. [emedicinehealth.com]

  In tension pneumothorax, patients are distressed with rapid laboured respirations, cyanosis, profuse diaphoresis, and tachycardia. [bestpractice.bmj.com]

  Decreased or absent breath sounds Hyperresonance on percussion Asymmetric lung expansion, mediastinal and tracheal shift with large pneumothorax Signs of tension pneumothorax Deviation of the trachea to the contralateral side, tachycardia, hypotension, cyanosis [rch.org.au]

  Symptoms of pneumothorax include: Sudden sharp pain that worsens with deep breathing Shortness of breath Chest tightness Fatigue Fast heart rate Bluish skin color (called cyanosis) Symptoms of hemothorax may include: Chest pain Shortness of breath Respiratory [bmc.org]

  Rapidly evolving hypotension, tachypnea, tachycardia and cyanosis should raise the suspicion of tension pneumothorax, which is, however, extremely rare in PSP. [err.ersjournals.com]

• Jugular Venous Distention

  Jugular venous distention and tracheal deviation are late and unreliable findings of tension pneumothorax [1,2]. [ems1.com]

• Fracture

  though rib fractures are not necessary for tension pneumothorax to occur. [emedicine.medscape.com]

  Penetrating trauma to the chest can fracture ribs or directly cause a collapsed lung. [emedicinehealth.com]

  The most important technique for diagnosing costal fracture is manual examination, he adds. If fractured bone has pierced the pleura, the patient may manifest shortness of breath, cough, and hemoptysis. [ncbi.nlm.nih.gov]

• Shoulder Pain

  I was dancing at a club when I suddenly again felt my all-to-familiar right chest and shoulder pain. I did not want to go to the hospital in the middle of that night, so I waited. [atsjournals.org]

  Common symptoms of a collapsed lung include: Sharp chest or shoulder pain, made worse by a deep breath or a cough Shortness of breath Nasal flaring (from shortness of breath) A larger pneumothorax causes more severe symptoms, including: Bluish color of [medlineplus.gov]

  Symptoms are more likely to develop at rest than during physical activity and may include: acute chest pain that improves over time shortness of breath back and shoulder pain Sometimes the heart is affected. This is called a tension pneumothorax. [childrensmn.org]

  Symptoms Common symptoms of a collapsed lung include: Sharp chest or shoulder pain, made worse by a deep breath or a cough Shortness of breath Nasal flaring (from shortness of breath) A larger pneumothorax causes more severe symptoms, including: Bluish [mountsinai.org]

• Left Shoulder Pain

  Again, as before, I was stricken with diffuse left shoulder pain. I took acetylsalicylic acid as a painkiller for a day. I felt tired and was uncomfortably short of breath. I stopped skiing, skipped dinner, and went early to bed. [atsjournals.org]

The mainstay in diagnosis of pneumothorax remains a thorough history and physical examination. In the case of tension pneumothorax, valuable time could be wasted if treatment is not instituted immediately the clinical diagnosis is made. However, investigations still have a role to play in determining the extent of the damage and the extent of the effect of the pneumothorax.

Investigations that may be carried out include blood tests to determine the degree of cardiopulmonary compromise. A chest radiograph would also be done to evaluate the extent of the condition and the effect on the mediastinum [8]. CT scan is the best imaging modality for use in pneumothorax but it is not routinely used. Ultrasound scan is also very useful when employed by a skilled sonologist.

• Atelectasis

  Many things can cause atelectasis. Depending on the cause, atelectasis is categorized as either obstructive or nonobstructive. Causes of obstructive atelectasis Obstructive atelectasis happens when a blockage develops in one of your airways. [healthline.com]

  Atelectasis Other names Collapsed lung[1] Atelectasis of a person's right lung Pronunciation Specialty Pulmonology Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. [en.wikipedia.org]

  Overview Atelectasis and pneumothorax are conditions in which the lung or part of the lung collapses, causing chest pain and difficulty breathing. [nm.org]

  There is no air in the pleural space normally The introduction of air into the pleural space separates the visceral from the parietal pleura In contradistinction, the visceral and parietal pleura usually do not separate from each other in obstructive atelectasis [learningradiology.com]

  These two conditions are known as pneumothorax and atelectasis. Commonly Confused Terms Let's face it. We all sometimes use an inappropriate word, like 'they're' instead of 'their,' by accident. [study.com]

• Pneumoperitoneum

  After the start of carbon dioxide-induced pneumoperitoneum, the patient's end-tidal carbon dioxide pressure and heart rate suddenly increased. [ncbi.nlm.nih.gov]

  Less commonly, air can encircle the heart, (Pneumopericardium), get under the skin, (Subcutaneous Emphysema), leak into the abdomen (Pneumoperitoneum) or surround the kidneys (Pneumoretroperitoneum). A baby often has more than one form of air leak. [unitypoint.org]

  […] ventilator radiofrequency (RF) ablation of lung mass endoscopic perforation of the esophagus central venous catheter insertion, nasogastric tube placement trauma: pulmonary laceration tracheobronchial rupture acupuncture 14,15 esophageal rupture Others pneumoperitoneum [radiopaedia.org]

  Kyobu Geka. 2011 May;64(5):430-433 (10) Catamenial pneumothorax associated with multiple diaphragmatic perforations and pneumoperitoneum in a reproductive woman. Baoquan L, Liangjian Z, Qiang W, Hai J, Hezhong C, Zhiyun X. [catamenial-pneumothorax.com]

• Pneumothorax on Chest X-Ray

  While clinical signs and obvious things, like gaping holes in someone's chest, are clues to a pneumothorax, a chest X-ray (radiograph) should be taken as well. [study.com]

  To tell if you have a pneumothorax, doctors listen to your breathing with a stethoscope. They’ll also do a chest x-ray or ultrasound. Treatment depends on how large your pneumothorax is. [msdmanuals.com]

  If a physician suspects a pneumothorax, a chest x-ray may be taken to confirm the diagnosis and to determine the amount of air present. [healthcentral.com]

  Diagnosis of pneumothorax A chest x-ray is used to diagnose a pneumothorax, though an ultrasound or CT scan are sometimes used. [healthdirect.gov.au]

The goal of treatment is to restore lung volume, get air out of the pleural space and to prevent recurrence. Procedures like simple aspiration, insertion of chest tube, insertion of a 1-way valve and thoracostomy with continuous suction will help to restore an air-free pleural space. Other procedures like video assisted thoracoscopic surgery and thoracotomy could be performed for pleurodesis or pleurectomy [9].

Drugs also have a role to play in pneumothorax caused by an underlying medical condition. Analgesics are used to relieve pain, benzodiazepines provide conscious sedation and antibiotics are used to reduce the risk of infection after a surgical procedure.

In patients who have uncomplicated pneumothorax, complete resolution occurs within 10 days. Primary spontaneous pneumothorax is usually benign and requires no medical intervention. Recurrence however occurs between 6 months to 3 years of the incident. It has a 5-year recurrence rate of 28 to 32% while the secondary type has a 5-year recurrence rate of 43%. Recurrence is commoner in smokers, patients with chronic obstructive pulmonary disease (COPD) and patients with AIDS. Deaths have been recorded in patients with the relatively benign primary spontaneous pneumothorax while the secondary type has a mortality rate of up to 17%. Tension pneumothorax is a rapidly evolving entity that quickly leads to death if intervention is not swift [6].

During inflation of the lungs, there is negative pressure in the pleural space. When air enters this space, it causes an increase in pressure, leading to a collapse of the lung. One of the major causes of this is trauma which could be either be due to accidents or could be iatrogenic. Other causes are ruptured blebs. Blebs are air blisters which are found on the surface of the lungs, they are harmless if the remain intact. It could also be caused by a chronic lung disease like cystic fibrosis [2].

The epidemiology is largely dependent on the type of pneumothorax. The primary spontaneous pneumothorax is more common in young adults between the ages of 20 years to 30 years, while the secondary type is more common in people aged between 60 years and 65 years. They are both commoner in men than in women and there is no recorded racial predilection. Smoking is also said to increase the risk of the secondary type spontaneous pneumothorax.

Iatrogenic pneumothorax occurs in 5 to 7 in every 100,000 hospital admissions largely due to the increased use of mechanical ventilation. A rare type, catamenial pneumothorax is seen only in women and occurs within 3 days after menstruation starts [3].

The pathophysiology varies with the cause of the pneumothorax. In spontaneuos pneumothorax, gas invades the pleural space usually from a ruptured bleb. This causes an increase in the pressure within the pleural space, so the lungs collapses within itself until the rupture is closed or equilibrium is reached. This reduces the size of the lungs equivalent to the amount of gas decreasing the vital capacity of the lung and reducing the partial pressure of oxygen [4].

Tension pneumothorax results as a consequence of disruption in the visceral or parietal pleura or the tracheobronchial tree. The injured tissue forms a one way valve so that there is inflow of air during inspiration but no outflow. The volume increases with each inspiratory movement and the pressure within the hemithorax builds. The affected lung then collapses and continued increase in pressure pushes the mediastinum to the opposite side. This shift impinges on the contralateral lung and also impairs venous return to the right atrium. The combination of the effects of the collapsed lung and the compressed one leads to hypoxia, which ultimately impairs cardiac function. This condition can rapidly progress to death if intervention is delayed [5].

Smoking is a recognized risk factor, so avoiding cigarettes reduce the risk of developing a pneumothorax. Other medical preventive measures are geared towards reducing the risk of recurrence.

Individuals with pneumothorax usually have a collapse of the lung on the affected side. The degree of collapse usually determines the clinical consequence. Also, symptoms are dependent on the type of pneumothorax [1].

• Definition: Pneumothorax is a condition that results from air entering the pleural space which causes the lung to collapse and this will affect breathing and heart function. It is a fairly common condition.
• Cause: A number of risk factors are associated with this condition including smoking, chronic lung diseases, pregnancy, AIDS, trauma and some medical procedures.
• Symptoms: The most common symptom is sudden chest pain, this pain feels like a stab and it radiates to the shoulder on the affected side. There is also sudden shortness of breath and you may notice the lips start to turn blue. There might also be cough, patients tend to feel anxious for their lives and have a general feeling of ill health.
• Diagnosis: This is usually done by examination as a quick identification of the condition is necessary to improve prognosis. Some tests might however be carried out to know the extent of the damage to the lung and heart functions.
• Treatment: For the milder cases, patients are observed and monitored for signs of worsening. The more severe cases involve the insertion of a chest tube to relieve the air pressure. If this fails, surgeries are carried out to obliterate the pleural space or remove part of the lungs [10].

1. Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.Am J Respir Crit Care Med. Jul 1 2006;174(1):26-30.
2. Gunji Y, Akiyoshi T, Sato T, Kurihara M, Tominaga S, Takahashi K. Mutations of the Birt Hogg Dube gene in patients with multiple lung cysts and recurrent pneumothorax. J Med Genet. Sep 2007;44(9):588-93.
3. Feldman AL, Sullivan JT, Passero MA, Lewis DC. Pneumothorax in polysubstance-abusing marijuana and tobacco smokers: three cases. J Subst Abuse. 1993;5(2):183-6. 
4. Flume PA, Strange C, Ye X, Ebeling M, Hulsey T, Clark LL. Pneumothorax in cystic fibrosis. Chest. Aug 2005;128(2):720-8.
5. Lee CC, Lee SH, Chang IJ, et al. Spontaneous pneumothorax associated with ankylosing spondylitis.Rheumatology (Oxford). Dec 2005;44(12):1538-41. 
6. Miller JS, Itani KM, Oza MD, Wall MJ. Gastric rupture with tension pneumoperitoneum: a complication of difficult endotracheal intubation. Ann Emerg Med. Sep 1997;30(3):343-6.
7. Iannoli ED, Litman RS. Tension pneumothorax during flexible fiberoptic bronchoscopy in a newborn. Anesth Analg. Mar 2002;94(3):512-3; table of contents.
8. Whale C, Hallam C. Tension pneumothorax related to acupuncture. Acupunct Med. Jun 2004;22(2):101; author reply 101-2.
9. Hearnshaw SA, Oppong K, Jaques B, Thompson NP. Tension pneumothorax as a complication of colonoscopy. Endoscopy. Feb 2004;36(2):190.
10. Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. Dec 1979;120(6):1379-82.