pulmonary disorders
Pneumothorax
Key Points
Primary spontaneous pneumothorax occurs in patients without underlying pulmonary disease, classically in tall, thin young men in their teens and 20s. Secondary spontaneous pneumothorax occurs in patients with underlying pulmonary disease; it most often results from rupture of a bleb or bulla in patients with severe chronic obstructive pulmonary disease. Diagnosis is by upright chest x-ray or ultrasonography, except for tension pneumothorax, which is diagnosed clinically as soon as suspected. Primary spontaneous pneumothorax that does not cause respiratory or cardiac symptoms can be safely observed without treatment if follow-up chest x-rays done at about 4 hours show no progression, with follow up regularly over the subsequent weeks. Symptomatic primary spontaneous pneumothoraces should be evacuated by catheter aspiration, ambulatory devices, or tube thoracostomy. Secondary and traumatic pneumothoraces are generally treated with tube thoracostomy. Video-assisted thoracic surgery (VATS) and other procedures can help prevent recurrences of spontaneous pneumothorax . 