기흉의 증상, 징후 (병력 청취 & 신체 진찰)

10대/남자

① 1시간 전부터 갑자기 시작된 # 흉통

② 숨을 크게 들여 마실 때 생기는 통증

→→ #기흉 (pneumothorax)일 수도 있으나

​

혼란 변수

① ant. sternum 부위의 통증, 몸을 움직일 때 통증, 평소 팔굽혀펴기 운동

→→ #늑골연골염 (costochondritis)이지 않을까?

② 불규칙한 심장 뛰기 시작한지 일주일 전 →→ 오늘 진단과 관련 없음

​

숨을 크게 들여 마실 때 흉부 가운데 부분이 아프고 흉부를 움직일 때 아프고 평소 팔굽혀펴기 운동을 하므로 늑골연골염을 추정하였으나 기흉으로 확인되었습니다. 1시간 전에 갑작스럽게 시작된 pleuritic chest pain이 가장 큰 hint였었던 같습니다.

​

Patients with pneumothorax classically present with the following:

History – Pneumothorax most often presents with sudden onset of dyspnea and pleuritic chest pain (갑작스런 발생, 호흡곤란과 흉막통). Since pneumothorax is usually unilateral, the pain is usually felt on the ipsilateral side, but may be central or bilateral in rare cases where pneumothorax is bilateral (흉부 가운데 부분이 아플 수 있다).

The intensity of dyspnea can range from mild to severe. The severity of the symptoms primarily relates to the volume of air in the pleural space and to the degree of pulmonary reserve, with dyspnea being more prominent if the pneumothorax is large and/or underlying disease is present.

Pneumothorax can present at all ages. Patients with primary spontaneous pneumothorax (PSP; ie, that associated with subpleural blebs in the absence of an underlying disorder) are typically in their early 20s; PSP is rare after age 40 years and classically occurs in young, tall, thin, smoking males (젊고 키가 크고 마른 남자. 흡연력은 확인하지 못함). In contrast, since most cases of secondary spontaneous pneumothorax (SSP; ie, that associated with underlying lung disease) are due to emphysema, these patients tend to be older. However, this finding is not absolute; for example, pneumothorax in patients with lymphangioleiomyomatosis or thoracic endometriosis presents in young, nonsmoking females of reproductive age.

​

Symptoms usually develop when the patient is at rest (갑자기 앉아 있다 증상이 시작되었다고 함), although occasionally, pneumothorax develops during exercise, air travel, scuba diving, or illicit drug use. Alternatively, symptoms may occur during or following an invasive procedure or trauma to the chest, neck, gut, or abdomen.

​

​

Ref. UpToDate 2023.03.04