Primary spontaneous pneumothorax

Case contributed by Adan Radiology Department
Diagnosis certain


The patient presented to our causality by chest pain in apparently healthy individuals without any significant past medical history.

Patient Data

Age: 20 years
Gender: Male

Day 0 (On admission).


The fontal chest radiographic image demonstrates classic appearances of right-sided pneumothorax with a readily apparent visceral pleural line is seen without distal lung markings.

The case courtesy Dr. Safwat Al Moghazi  MD

Day 0 (On admission).


A large-bore chest drain with a satisfactory position.

The case courtesy Dr. Safwat Al Moghazi  MD

Day 3

  • bilateral apical subpleural blebs are more evident on the right side and bilateral apical minimal reticulation are seen. 
  • Mild left lower lobe peri-bronchial nodular infiltrations are seen suggestive of bronchopneumonia  
  • A successful chest tube is noted in the right pleural space with no significant residual pneumothorax that could be detected currently.  
  • Otherwise unremarkable CT Chest.

The case courtesy Dr. Safwat Al Moghazi  MD

Day 10


Recurrence of pneumothorax after a single episode and removable chest tube. 

The case courtesy Dr. Safwat Al Moghazi  MD.

Annotated image


PA view chest radiograph in full inspiration demonstrates a thin white line of the visceral pleura ( red arrows) from a small right pneumothorax.

Case Discussion

A 20-year-old male presented to the emergency department with the acute onset of shortness of breath and chest discomfort. The patient was with no significant past medical history.

Chest radiographs on admission demonstrate right-sided pneumothorax with suspicion of apical blebs.

The post-procedure film demonstrated reexpansion and minimal right apical blebs.

CT chest is of value in the detection and confirmation of apical pleural blebs in patients with primary spontaneous pneumothorax (PSP).

On CT, particular attention should be paid to the lung apices, where the majority of blebs are located. Prompt diagnosis of a morphological abnormality in these patients.

Our case is a good example and typical case scenario of primary spontaneous pneumothorax. The typical person who presents with a primary spontaneous pneumothorax has an asthenic body habitus, being taller and thinner than the average person. The primary spontaneous pneumothorax (PSP) is most likely to be associated with apical subpleural blebs; there is a significant risk of recurrence.

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