Symptomatic pneumothorax (summary)

Dr Jeremy Jones et al.

Pneumothoraces (singular: pneumothorax) are collections of gas within the pleural space. If the pneumothorax is under pressure, it is called a tension pneumothorax.

Reference article

This is a summary article; read more in our article on pneumothorax.

  • epidemiology
    • wide range of patients present with pneumothoraces
    • reflects the multiple potential causes
  • presentation
    • spontaneous pain
    • post-trauma
  • pathophysiology
    • primary spontaneous
      • no underlying lung disease
      • pleural bleb or bulla rupture
    • secondary spontaneous: underlying lung disease, e.g. asthmaCOPD
    • secondary: to trauma, e.g. car accident, stabbing, gunshot, medical intervention (post lung biopsy)
  • investigation
    • chest x-ray
      • first line investigation
      • relatively high yield apart from small pneumothoraces
    • CT chest
      • trauma
      • suspicion of small pneumothorax and normal x-ray
  • treatment
    • small pneumothorax with minimal symptoms
      • primary spontaneous pneumothorax: discharge with early outpatient follow-up and advised to return if symptomatic
      • secondary pneumothorax: observe with high-flow oxygen therapy and consider intervention
    • symptomatic pneumothorax

To make the diagnosis of a pneumothorax, look for:

  • peripheral lucency
  • a lung edge
  • absence of lung markings peripheral to visible lung edge

On an erect chest radiograph, a pneumothorax will usually be apical. If it is small, it can be difficult to see. Look carefully in the region above the line of the clavicle.

If there is a pneumothorax, check for the position of the mediastinum. If the pneumothorax is under pressure, there may be compression of the heart and great vessels with displacement of the mediastinum away from the pneumothorax. This is called a tension pneumothorax and must be treated with urgency.

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Article Information

rID: 30104
System: Chest
Synonyms or Alternate Spellings:

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Cases and Figures

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    Case 1: right sided pneumothorax
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    Case 2: large left sided pneumothorax
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    Case 3: right sided pneumothorax
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    Case 4: apical bleb and pneumothorax
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