Last reviewed: August 2019
Last updated: July  2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • dyspnoea
  • hyperexpanded ipsilateral hemithorax
  • hyper-resonant ipsilateral hemithorax
  • ipsilateral absent or diminished breath sounds
  • extreme breathlessness
  • trachea shifted to contralateral side

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

  • CT chest
  • chest ultrasound
  • bronchoscopy
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor of Medicine and Oncology

Clinical Director, Division of Pulmonary and Critical Care

Director, Interventional Pulmonology Research Core

Johns Hopkins Medical Institutions




LY has received research grants and consulting fees from Olympus, Inc, the manufacturer of the Spiration intrabronchial valve.

Assistant Professor of Medicine

Director, Interventional Pulmonology

Carolina Center for Pleural Disease

University of North Carolina

Chapel Hill



JA declares that he has no competing interests.

Dr Lonny Yarmus and Dr Jason Akulian would like to gratefully acknowledge Dr Ryland P. Byrd Jr, Dr Thomas M. Roy, and Dr Anita Alwani, previous contributors to this topic.

Peer reviewers VIEW ALL

Professor and Chief Executive Officer of Respiratory Division

Interventional Endoscopy Clinic

University Hospital Brussels




MN declares that he has no competing interests.

Professor of Medicine

Division of Pulmonary Critical Care, Allergy and Sleep Medicine

Medical University of South Carolina




SAS declares that he has no competing interests.

Use of this content is subject to our disclaimer