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What Breath Sounds Are Heard With Pneumothorax?

An abnormal collection of air in the pleural space is known as a pneumothorax. Pleural space is a space between the lung and the chest wall. It is a thin fluid filled space between the two pulmonary pleurae. The outer pleura, which is called the parietal pleura is joined to the chest wall and the inner pleura called the visceral pleura is joined to the lungs and the adjoining structures. This is the space where, when the air gets accumulated, it is known as a pneumothorax.

Now, before knowing what breath sounds are heard in pneumothorax, let us first see the types of breath sounds.

There are four types of breath sounds- tracheal, bronchial, bronchovesicular and vesicular breath sounds.

Tracheal- these are heard over the trachea. These are harsh sounds and seem like air is passing through a pipe.

Bronchial- these sounds are loud and high in pitch and are heard near the space between the second and the third rib, more near the sternum

Bronchovesicular- these are heard in the space between the first and the second rib, and are softer than bronchial sounds

Vesicular- these are heard through most of the lung fields and are softer.

In a pneumothorax, these breath sounds may be diminished or sometimes absent, as the air affects the transmission of sounds. But, this may not be correlated as sometimes the pneumothorax is very small.

A primary chest auscultation therefore may not prove to be adequate to diagnose a pneumothorax. Other supportive tests are necessary to confirm the diagnosis.

Types of Pneumothorax

There are different classifications in use to describe the different types of pneumothorax. One major classification states that pneumothorax is of two types- non traumatic and traumatic. The non-traumatic pneumothorax is described as the one wherein there is no history or evidence of trauma to the lungs. Also, it is seen to be occurring spontaneously. Hence it is also known as spontaneous pneumothorax. This again, is classified into two further types- primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP). primary spontaneous pneumothorax is a condition caused without any apparent cause and without the presence of any lung disease, whereas a secondary spontaneous pneumothorax is seen when there is a presence of a lung disease, like COPD, asthma, TB, etc.

The traumatic type, as the name suggests, occurs because of a trauma to the chest and lungs.

Signs And Symptoms of a Pneumothorax

The primary spontaneous pneumothorax (PSP), as stated above, occurs in the absence of any underlying lung disease. The symptoms are comparatively milder and may often go unnoticed. Chest pain or mild breathlessness may be present at times. This type is more seen to be occurring due to changes in the atmospheric pressure.

The secondary spontaneous pneumothorax (SSP) occurs in persons with another underlying lung disease. The signs and symptoms in this type are comparatively severe than the ones seen in primary spontaneous pneumothorax (PSP). Hypoxemia is the primary symptom, which means there is a considerable decrease in the blood-oxygen levels. This may be paired at times with hypercapnia, which means the carbon dioxide levels increase in the blood, resulting in confusion, and sometimes, even coma.

Therefore, a sudden breathlessness in persons suffering from a lung disease, or a sudden onset of any other such symptoms, should be immediately brought to the notice of the physician.

Traumatic pneumothorax occurs when the chest wall is pierced due to some severe trauma, and air enters the pleural space. This can also happen due to mechanical trauma, like in case of mechanical ventilation.

There is another type of pneumothorax known as tension pneumothorax. This type is generally considered to be occurring when any of the above mentioned pneumothoraces precipitates into significant damage to the respiration and blood circulation, or one of the two. Tension pneumothorax mostly appears in trauma, lung disease, resuscitation etc. chest pain and respiratory distress are the most significant symptoms here.

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What Breath Sounds Are Heard With Pneumothorax?