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Spontaneous pneumothorax refers to a pneumothorax that occurs without any obvious cause - unrelated to trauma or an invasive procedure. The focus of this chapter is primary spontaneous pneumothorax (PSP), which occurs spontaneously in a patient without an underlying lung disease. This is in contrast to secondary spontaneous pneumothorax, which occurs as a result of underlying lung disease such as asthma, cystic fibrosis, interstitial lung disease, fibroconnective tissue disorders (e.g. Marfan syndrome, Ehlers-Danlos syndrome), infection, malignancy or a congenital lung malformation . The underlying etiology for PSP is often previously undiagnosed bullae (i.e. blebs) which are abnormal cyst like lesions on the lung surface that can rupture and leak air into the pleural space. Patients with PSP will often present with symptoms of chest pain and/or mild dyspnea but rarely hemodynamic compromise or tension pneumothorax physiology. Physical exam may find decreased breath sounds on the affected side but can be normal with a small pneumothorax. The diagnosis is confirmed by chest radiograph .
The initial treatment for PSP may involve observation if the pneumothorax is very small and the patient is clinically stable with minimal symptoms. A moderate to large PSP requires intervention to evacuate the air from the pleural space and re-expand the lung. Treatment options include a simple aspiration, insertion of a thoracostomy tube or video assisted thoracoscopic surgery (VATS) with resection of the blebs. Pleurodesis may be performed with the aim to reduce the likelihood of recurrent pneumothorax - a not uncommon outcome. Patients with a chest tube may undergo chemical pleurodesis through the chest tube, while those treated with VATS will typically undergo either mechanical pleurodesis via pleural abrasion or pleurectomy.
Content in this topic is referenced in SCORE Pneumothorax