Spontaneous pneumothorax

Case contributed by Anil Kumar Geetha Virupakshappa
Diagnosis certain

Presentation

Acute onset left sided chest pain.

Patient Data

Age: 25 years
Gender: Male

Presentation

x-ray

Large tension pneumothorax on left side is noted with near complete collapse of the left lung and mild mediastinal shift towards right side.

Right lung appears clear. Bony thoracic cage appear normal. No pleural effusion.

After chest drain insertion

x-ray

Significant expansion of the previously collapsed left lung, immediately following chest drain insertion and also reduction in mediastinal shift.

Next day

x-ray

Next day chest x-ray showing expanding left lung with significant residual pneumothorax. Thin surgical emphysema is noted involving left chest wall.

6 days later

x-ray

Complete resolution of pneumothorax on 6th day with complete expansion of lung.

Case Discussion

Pneumothoraces are categorized into three types:

  1. Primary spontaneous: no underlying lung disease
  2. Secondary spontaneous: underlying lung disease is present
  3. Iatrogenic/traumatic

The most common causes of secondary spontaneous pneumothorax are cystic lung diseases like bullae or blebs, emphysema, lymphangioleiomyomatosis, Langerhans cell histiocytosis, and ankylosing spondylitis.

Treatment depends on size and symptoms.

Pneumothorax with significant symptoms requires intercostal drain insertion as in this case.

These series of chest x-rays show the management until complete recovery.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.