Pneumothorax

Last reviewed: 7 Jun 2022
Last updated: 09 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea
  • hyperexpanded ipsilateral hemithorax
  • hyper-resonant ipsilateral hemithorax
  • ipsilateral absent or diminished breath sounds
  • extreme breathlessness
  • trachea shifted to contralateral side
More key diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
More 1st investigations to order

Investigations to consider

  • CT chest
  • chest ultrasound
  • bronchoscopy
More investigations to consider

Treatment algorithm

INITIAL

tension pneumothorax

ACUTE

primary spontaneous pneumothorax AND patient ≤ 50 years old

secondary spontaneous pneumothorax OR patient > 50 years old

traumatic pneumothorax

pneumothorax ex vacuo

Contributors

Authors

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

Disclosures

LY declares that he has no competing interests.

Jason Akulian, MD, MPH

Assistant Professor of Medicine

Director, Interventional Pulmonology

Carolina Center for Pleural Disease

University of North Carolina

Chapel Hill

NC

Disclosures

JA declares that he has no competing interests.

Acknowledgements

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.

Disclosures

RPB, TMR, and AA declare that they have no competing interests.

Peer reviewers

Marc Noppen, MD

Professor and Chief Executive Officer of Respiratory Division

Interventional Endoscopy Clinic

University Hospital Brussels

Brussels

Belgium

Disclosures

MN declares that he has no competing interests.

Steve A. Sahn, MD

Professor of Medicine

Division of Pulmonary Critical Care, Allergy and Sleep Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

SAS declares that he has no competing interests.

  • Pneumothorax images
  • Differentials

    • Asthma, acute exacerbation
    • COPD, acute exacerbation
    • Pulmonary embolism
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: intensive care unit patients
    • ACR appropriateness criteria: rib fractures
    More Guidelines
  • Patient leaflets

    Pneumothorax

    Chest drain insertion

    More Patient leaflets
  • Videos

    Needle decompression of tension pneumothorax: animated demonstration

    Insertion of intercostal drain, Seldinger technique: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer