On auscultation, which finding suggests a right pneumothorax?
A. Bilateral inspiratory and expiratory crackles.
B. Absence of breaths sound in the right thorax.
C. Inspiratory wheezes in the right thorax.
D. Bilateral pleural friction rub.
Correct Answer: B. Absence of breaths sound in the right thorax
In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. The degree of collapse determines the clinical presentation of pneumothorax. None of the other options are associated with pneumothorax.
Option A: Bilateral crackles may result from pulmonary congestion. Pneumonia is an infection in the lungs. It may be in one or both lungs. The infection causes air sacs in the lungs to become pus-filled and inflamed. This causes a cough, difficulty breathing, and crackles. Pneumonia may be mild or life-threatening.
Option C: Inspiratory wheezes may signal asthma. Asthma is a heterogeneous syndrome characterized by variable, reversible airway obstruction and abnormally increased responsiveness (hyperreactivity) of the airways to various stimuli. The syndrome is characterized by wheezing, chest tightness, dyspnea, and/or cough, and results from widespread contraction of tracheobronchial smooth muscle (bronchoconstriction), hypersecretion of mucus, and mucosal edema, all of which narrow the caliber of the airways.
Option D: A pleural friction rub may indicate pleural inflammation. Auscultation of a pleural friction rub can occur when the normally smooth surfaces of the visceral and parietal pleura become roughened by inflammation. A pleural friction rub is an adventitious breath sound heard on auscultation of the lung. The pleural rub sound results from the movement of inflamed and roughened pleural surfaces against one another during movement of the chest wall. This sound is non-musical, and described as “grating,” “creaky,” or “the sound made by walking on fresh snow.”
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