Overview
What are the signs and symptoms of pneumothorax?
Which respiratory findings suggest pneumothorax?
Which cardiovascular findings suggest pneumothorax?
What are the physical findings specific to each type of pneumothorax?
What is the role of lab studies in the diagnosis of pneumothorax?
What is the role of imaging studies in the diagnosis of pneumothorax?
What are the treatment options for pneumothorax?
What is the role of surgery in the treatment of pneumothorax?
Which medications are used in the treatment of pneumothorax?
What is primary spontaneous pneumothorax (PSP)?
What is secondary spontaneous pneumothorax (SSP)?
What is iatrogenic pneumothorax?
What is traumatic pneumothorax?
What is the relevant anatomy of pneumothorax?
What is the pathophysiology of spontaneous pneumothorax?
What is the pathophysiology of tension pneumothorax?
What is the role of pneumomediastinum in the pathophysiology of pneumothorax?
What are risk factors for primary spontaneous pneumothorax (PSP)?
Which conditions are associated with secondary spontaneous pneumothorax?
What are risk factors for secondary spontaneous pneumothorax (SSP)?
What causes iatrogenic pneumothorax?
What causes traumatic pneumothorax?
What causes tension pneumothorax?
What causes pneumomediastinum?
Which patient groups are at highest risk for spontaneous pneumothorax?
What is the incidence of iatrogenic and traumatic pneumothorax?
What is the prevalence of tension pneumothorax?
In which patient groups is catamenial pneumothorax most likely to occur?
What is the incidence of pneumomediastinum?
What is the prognosis of pneumothorax?
What is the prognosis of tension pneumothorax?
What is the prognosis of pneumomediastinum?
What restrictions should patients with pneumothorax be given?
Which activities are forbidden for patients recovering from pneumothorax?
What are the risks of smoking in patients with pneumothorax?
Presentation
What are the signs and symptoms of spontaneous and iatrogenic pneumothorax?
What are the signs and symptoms of tension pneumothorax?
What are the signs and symptoms of catamenial pneumothorax?
What are the signs and symptoms of pneumomediastinum?
What are general physical findings characteristic of pneumothorax?
What are respiratory findings characteristic of pneumothorax?
What are cardiovascular findings characteristic of pneumothorax?
What are physical findings characteristic of spontaneous and iatrogenic pneumothorax?
What are physical findings characteristic of tension pneumothorax?
What are physical findings characteristic of pneumomediastinum?
DDX
What should be considered in the diagnosis of pneumothorax?
Which conditions should be considered in the differential diagnoses of pneumothorax?
What are the differential diagnoses for Pneumothorax?
Workup
How is pneumothorax diagnosed?
What is the primary concern in the initial evaluation of pneumothorax following a trauma?
How is tension pneumothorax diagnosed?
What is the role of arterial blood gas (ABG) studies in the diagnosis of pneumothorax?
How should a chest radiograph be evaluated for pneumothorax?
Which findings on chest radiographs suggest pneumothorax?
What is the role of chest radiograph in the evaluation of tension pneumothorax?
Which findings on chest radiography suggest pneumomediastinum?
How is the size of the pneumothorax estimated on chest radiograph?
What are limitations of chest radiographs in the evaluation of pneumothorax?
When are lateral decubitus radiographs indicated for the evaluation of pneumothorax?
When is contrast-enhanced esophagography indicated in the evaluation of pneumothorax?
What is the role of a chest CT scan in the evaluation of pneumothorax?
Which findings on chest CT suggest spontaneous pneumothorax?
What is the role of chest CT in the evaluation of traumatic and tension pneumothorax?
What is the role of chest CT in the evaluation of pneumomediastinum?
What is the role of ultrasonography in the evaluation of pneumothorax?
Which ultrasound findings suggest pneumothorax?
What are advantages of ultrasound in the evaluation of pneumothorax?
What are limitations of ultrasound in the evaluation of pneumothorax?
Treatment
What is the basis for treatment selection in pneumothorax?
What is the role of drug treatment for pneumothorax?
What is the role of risk stratification in the management of pneumothorax?
What are possible presentations of pneumothorax?
What are the classifications of pneumothorax resolution?
What are the classifications of pneumothorax recurrence?
What determines the level of care needed for pneumothorax?
At what interval should patients be monitored following diagnosis of a pneumothorax?
What are the options for restoring air-free plural space in pneumothorax?
What are the options for restoring air-free plural space in asymptomatic pneumothorax?
What is the role of supplemental oxygen in the management of pneumothorax?
What is the role of simple aspiration in the management of pneumothorax?
How are chest tubes placed during treatment of pneumothorax?
What is the role of a one-way valve system in the management of pneumothorax?
What is the role of thoracostomy in the management of pneumothorax?
What is included in prehospital care for pneumothorax?
What is included in prehospital care for tension pneumothorax?
What is the role of ultrasonography in prehospital care of pneumothorax?
What is included in the initial emergency department (ED) care of pneumothorax?
What is the initial emergency department (ED) care for spontaneous pneumothorax?
What is the initial emergency department (ED) care for iatrogenic and traumatic pneumothorax?
What is the initial emergency department (ED) care for tension pneumothorax?
How should catamenial pneumothorax be managed?
What is the initial emergency department (ED) care for pneumomediastinum?
What is the role of surgery in the treatment of pneumothorax?
When is video-assisted thoracoscopic surgery (VATS) indicated for treatment of pneumothorax?
What is the role of pleurodesis in the treatment of pneumothorax?
What is the most common complications of pneumothorax treatments?
What are possible complications of pneumothorax?
What are surgical complications of pneumothorax?
What are risk factors for reexpansion pulmonary edema in pneumothorax?
What are possible complications of tension pneumothorax?
Which specialist consultations are needed for the treatment of pneumothorax?
What should be included in long-term monitoring following a pneumothorax?
What is the efficacy of nonsurgical pleurodesis in the prevention of pneumothorax recurrence?
How is recurrent pneumothorax prevented?
What are the rates of recurrent pneumothorax?
What is the efficacy of surgical pleurodesis in the prevention of pneumothorax recurrence?
Medications
What types of medication are used in the treatment of pneumothorax?
Which medications in the drug class Antibiotics are used in the treatment of Pneumothorax?
Which medications in the drug class Benzodiazepines are used in the treatment of Pneumothorax?
Which medications in the drug class Opiate Analgesics are used in the treatment of Pneumothorax?
Which medications in the drug class Local Anesthetics are used in the treatment of Pneumothorax?
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Radiograph of a patient with a small spontaneous primary pneumothorax
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Close radiographic view of patient with a small spontaneous primary pneumothorax (same patient as from the previous image).
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Expiratory radiograph of a patient with a small spontaneous primary pneumothorax (same patient as in the previous images).
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Radiograph of a patient with spontaneous primary pneumothorax due to a left upper lobe bleb.
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Close radiographic view of a patient with spontaneous primary pneumothorax due to a left upper lobe bleb (same patient as in the previous image).
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Radiograph of a patient with a large spontaneous tension pneumothorax.
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Radiograph showing subcutaneous emphysema and pneumothorax.
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This chest radiograph has 2 abnormalities: (1) tension pneumothorax and (2) potentially life-saving intervention delayed while waiting for x-ray results. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation.
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Radiograph of a new left-sided pneumothorax in a patient on mechanical ventilation, requiring high inflation pressures.
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Radiograph of a patient with a complete right-sided pneumothorax due to a stab wound.
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Radiograph of a patient with idiopathic pulmonary fibrosis and a small pneumothorax, following video-assisted thoracoscopic surgery (VATS) lung biopsy.
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Close radiographic view of a small pneumothorax in a patient with idiopathic pulmonary fibrosis, following video-assisted thoracoscopic surgery (VATS) lung biopsy (same patient as in the previous image). Note that the hole on a chest tube is outside the pleural space.
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Radiograph depicting a right-sided iatrogenic pneumothorax after transbronchial biopsy.
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Pneumomediastinum from barotrauma may result in tension pneumothorax and obstructive shock.
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Radiograph of a patient in the intensive care unit (ICU) who developed pneumopericardium as a manifestation of barotrauma.
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Radiograph of an older man who was admitted to the intensive care unit (ICU) postoperatively. Note the right-sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right-sided bronchial tree. Marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax. The endotracheal tube is in a good position.
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Radiograph depicting right main stem intubation that resulted in left-sided tension pneumothorax, right mediastinal shift, deep sulcus sign, and subpulmonic pneumothorax.
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This is a chest radiograph of an elderly male with chronic obstructive pulmonary disease who presented with a second left-sided spontaneous pneumothorax in 2 months. Chest thoracostomy was performed, the patient was admitted, and talc pleurodesis was performed the next day.
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This chest radiograph shows pneumomediastinum (radiolucency noted around the left heart border) in this patient who had a respiratory and circulatory arrest in the emergency department after experiencing multiple episodes of vomiting and a rigid abdomen. The patient was taken immediately to the operating room, where a large rupture of the esophagus was repaired.
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Radiograph demonstrating tension and traumatic pneumothorax.
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Radiograph demonstrating tension and traumatic pneumothorax.
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Lateral radiograph demonstrating tension and traumatic pneumothorax.
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Lateral radiograph demonstrating tension and traumatic pneumothorax.
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Chest radiograph depicting tension and traumatic pneumothorax.
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Lateral radiograph depicting tension and traumatic pneumothorax.
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Computed tomography scan demonstrating blebs in a patient with chronic obstructive pulmonary disease (COPD).
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Computed tomography scan demonstrating a bulla in an asymptomatic patient.
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Computed tomography scan demonstrating secondary spontaneous pneumothorax (SSP) from radiation/chemotherapy for lymphoma.
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Computed tomography scan demonstrating emphysematouslike changes (ELCs) in a patient with chronic obstructive pulmonary disease (COPD).
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Computed tomography scan in a patient with a history of bilateral pleurodesis and a strong family history of spontaneous pneumothorax.
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Illustration depicting multiple fractures of the left upper chest wall. The first rib is often fractured posteriorly (black arrows). If multiple rib fractures occur along the midlateral (red arrows) or anterior chest wall (blue arrows), a flail chest (dotted black lines) may result, which may result in pneumothorax.
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Insertion of chest tube. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Treatment Based on Risk Stratification
- Options for Restoring Air-Free Pleural Space
- Prehospital Care
- Hospital Management
- Indications for Surgical Assistance
- Video-Assisted Thoracoscopic Surgery
- Thoracotomy
- Pleurodesis
- Complications
- Prevention
- Consultations
- Long-Term Monitoring
- Show All
- Medication
- Questions & Answers
- Media Gallery
- References