Retractions paired with expiratory wheezing are indicative of which issue?

Retractions paired with expiratory wheezing suggest a lower airway obstruction. This is primarily because when there is a blockage or narrowing in the airways, it can lead to difficulty in exhaling air, which often results in wheezing sounds. Expiratory wheezing occurs specifically during the expiration phase of breathing when the narrowed airways cause turbulent airflow.

Retractions, which are the visible sinking in of the skin above the collarbone or between the ribs during inhalation, further indicate respiratory distress, often seen when the respiratory muscles are working harder to overcome the obstruction. Together, these signs highlight that there is resistance to airflow in the lower airways, leading to inadequate ventilation and impaired air exchange.

The other conditions listed—central nervous system injury, congestive heart failure, and pneumothorax—can cause respiratory symptoms, but they typically present differently and are associated with distinct physical exam findings or mechanisms of respiratory compromise. For example, central nervous system injuries may affect the drive to breathe, but not typically present with wheezing. Congestive heart failure usually leads to pulmonary congestion and might cause crackles rather than wheezing, while a pneumothorax would present with sudden chest pain and decreased lung sounds on one side rather than wheezing