Symptoms are related to the size of the pneumothorax and rate of development. Patients with mild symptoms may not come for evaluation, whereas those with underlying lung disease may arrive in extremis. Patients with secondary spontaneous pneumothoraces present more dramatically than those with primary pneumothoraces. Tension pneumothorax is rare in PSP/SSP but requires immediate treatment by needle decompression and expeditious chest tube thoracostomy based on clinical signs. Pneumothorax is an important differential diagnosis in patients with chest pain, since it can mimic ischemia causing ST changes and T-wave inversion on the ECG.3
Acute pleuritic chest pain occurs in 95 percent of patients and localizes to the side of the pneumothorax in > 90 percent of cases. 6 Dyspnea occurs in 80 percent and predicts a larger pneumothorax.6 Patients with COPD may acutely decompensate, with 1 to 17 percent mortality. Decreased breath sounds occur over the affected lung 85 percent of the time, but only 5 percent have tachypnea of more than 24 breaths per minute or tachycardia of more than 120 beats per minute. 6 Hyperresonance occurs in fewer than one-third. Tracheal deviation and hemodynamic compromise are the hallmarks of tension pneumothorax that demands immediate treatment.
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