Pneumothorax

Overview

Snapshot

A 13-year-old boy with cystic fibrosis presents to the emergency department with S. aureus pneumonia. He suddenly develops increased respiratory distress, pleuritic chest pain, and decreased breath sounds in the left chest.

Introduction

Pneumothorax results from air trapped in the pleural space that collapses a portion of the ipsilateral lung
Etiologies
- primary spontaneous
  - caused by rupture of the subpleural apical blebs
  - usually occurs in tall, thin males
- secondary spontaneous
  - spontaneous pneumothorax in the setting of underlying lung disease (ie COPD, TB, trauma, pneumocystis pneumonia, S. aureus)
- trauma
  - including iatrogenic
subclavian access has the highest risk of pneumothorax due to the proximity to the apices of the lungs

Presentation

Symptoms
- sudden-onset, unilateral, pleuritic chest pain
- dyspnea
- acute respiratory distress
Physical exam
- decreased or absent breath sounds
- hyperresonant to percussion
- decreased or absent tactile fremitus
may see tracheal deviation if tension pneumothorax present

Evaluation