Pneumothorax

A pneumothorax is defined as a collection of air between the lung and the chest wall. It can occur spontaneously without lung disease (primary spontaneous pneumothorax) or with underlying lung disease (secondary spontaneous pneumothorax). Trauma, iatrogenic complications of medical procedures and catamenial pneumothorax are other recognized causes. Breathlessness and chest pain are common symptoms. Chest X-ray is the most important investigation to detect and monitor a pneumothorax. Computed tomography of the chest has been widely used as it provides information about the underlying cause and helps to guide intervention. Management of pneumothorax is now based on the severity of symptoms, with a trend to manage less symptomatic patients conservatively. Drainage can be carried out by needle aspiration, chest drain insertion and ambulatory devices with a one-way Heimlich valve to allow outpatient management. Surgery is indicated in patients with prolonged air leak, or after a second episode of pneumothorax to prevent recurrence. Less invasive strategies such as talc and blood patch pleurodesis, and endobronchial valves, are available for patients unfit for surgery. Smoking cessation reduces the risk of recurrence and should be strongly encouraged.