Pneumothorax: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes, and sclerae (white part of the eye) [central cyanosis (bluish discoloration of skin and central mucous membranes, e.g., tongue); palpation of soft tissue emphysema/diseased air accumulation in soft tissues, if necessary].
      • Neck vein congestion [bulging neck veins]
      • Thoracic excursions [asymmetric respiratory movements of the thorax/chest]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Pulse palpation [pulsus paradox: drop in systolic blood pressure > 10 mmHg during inspiration (inspiration), with the consequence that the pulse is significantly attenuated during inspiration (due tocompression of the heart): tension pneumothorax].
    • Auscultation (listening) of the heart.
    • Examination of the lungs
      • Auscultation (listening) of the lungs [inspiratory and expiratory (on inhalation and exhalation): diminished breath sound/one-sided attenuated or abolished breath sound].
      • Bronchophony (checking the conduction of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs) [increased sound conduction due to pulmonary infiltration/compaction of the lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent): e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
      • Percussion (tapping) of the lungs [hypersonoric tapping sound].
      • Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with pleural effusion, pneumothorax, emphysema). As a result, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]

Square brackets [ ] indicate possible pathological (pathological) physical findings.