Last reviewed: June 2020
Last updated: July  2020

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnoea
  • ipsilateral reduced breath sounds
  • ipsilateral hyperinflation of the hemithorax with hyper-resonance on percussion
  • hypoxia
  • risk factors
  • cardiopulmonary deterioration
  • trachea shifted to the contralateral side
  • sweating

Risk factors

  • cigarette smoking
  • family history of pneumothorax
  • tall and slender body build
  • age <40 years
  • recent invasive medical procedure
  • chest trauma
  • acute severe asthma
  • COPD
  • tuberculosis
  • AIDS-related Pneumocystis jirovecii infection
  • cystic fibrosis
  • lymphangioleiomyomatosis
  • Marfan syndrome
  • homocystinuria
  • primary lung cancer and metastatic cancer to the lungs
  • Birt-Hogg-Dube syndrome
  • pulmonary Langerhans cell histiocytosis
  • Erdheim-Chester disease

Diagnostic investigations

Investigations to consider

  • chest ultrasound
  • CT chest
  • arterial blood gas (ABG)
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

Biography

JB is Chair of the British Thoracic Society.

Disclosures

JB declares that he has no competing interests.

Clinical Fellow Lung Cancer and Interventional Pulmonology

Glenfield Hospital 

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

CV declares that she has no competing interests.

Respiratory Registrar

Glenfield Hospital

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

OU declares that she has no competing interests.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Lonny Yarmus, DO, MBA

Associate Professor of Medicine and Oncology

Clinical Director, Division of Pulmonary and Critical Care

Director, Interventional Pulmonology Research Core

Johns Hopkins Medical Institutions

Baltimore

MD

Jason Akulian, MD, MPH

Assistant Professor of Medicine

Director, Interventional Pulmonology

Carolina Center for Pleural Disease

University of North Carolina

Chapel Hill

NC

Disclosures

LY has received research grants and consulting fees from Olympus, Inc, the manufacturer of the Spiration intrabronchial valve. JA declares that he has no competing interests.

Peer reviewersVIEW ALL

Associate Postgraduate Dean

Health Education England

Royal College of Physicians College Tutor

Consultant Respiratory Physician

Watford General Hospital

West Hertfordshire Hospitals NHS Trust

Disclosures

MK was collaborator and site principal investigator for the randomised ambulatory management of primary pneumothorax (RAMPP) trial, which received funding from Rocket Medical. MK has attended meetings sponsored by Rocket Medical.

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Head of Editorial, BMJ Best Practice

Disclosures

AE declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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