Fact-sheet: Pneumothorax


Updated on 03/04/2025 at 10:13 PM

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Definition

Presence of air between the pleural layers.

Primary: patient without underlying lung disease

Secondary: presence of underlying lung disease or other condition:

  • trauma
  • iatrogenic (central line placement, mechanical ventilation, pleural puncture, lung biopsy, etc.)
  • Asthma
  • emphysema
  • lymphangioleiomyomatosis - tuberous sclerosis.
  • infectious (tuberculosis)

Clinical features

Dyspnea
Lateralized chest pain
Decreased breath sounds and vocal fremitus
Cough with position changes
Tympanic percussion

Radiography

Outer margin of the visceral pleura visualized as a thin line crossing the posterior rib arc, separated from the chest wall by an avascular gas crescent manifesting as a homogeneous lucency devoid of pulmonary parenchymal structure

Look for signs of severity:

  • Mediastinal shift to the contralateral side
  • Flattening of the ipsilateral hemidiaphragm
  • Chest wall expansion and a dense lung collapsed at the hilum.

Mixed gas and fluid effusion, or hydropneumothorax, manifests as an air-fluid level on upright imaging.

It results from a penetrating wound or a bronchopleural fistula.

Specify whether the pneumothorax is complete (hyperlucency between the chest wall and the parenchyma retracted at the hilum) or partial.

If and only if not detectable on the initial radiograph, obtain a forced expiratory view.

CT

Positive diagnosis: visualization of pleural detachment with a gas crescent between the chest wall and the pleura.

Look for a possible etiology:

- apical blebs or bullae (particularly during preoperative workup for recurrent spontaneous pneumothorax or in "at-risk" occupations (divers, pilots)

- underlying lung disease (emphysema, cystic lung disease, Langerhans cell histiocytosis)

Management

Favorable outcome in 90% of cases (rest or chest tube drainage)