Presentation
Acute onset left sided chest pain.
Patient Data
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.
Significant expansion of the previously collapsed left lung, immediately following chest drain insertion and also reduction in mediastinal shift.
Next day chest x-ray showing expanding left lung with significant residual pneumothorax. Thin surgical emphysema is noted involving left chest wall.
Complete resolution of pneumothorax on 6th day with complete expansion of lung.
Case Discussion
Pneumothoraces are categorized into three types:
- Primary spontaneous: no underlying lung disease
- Secondary spontaneous: underlying lung disease is present
- 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.