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
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
1st investigations to order
- chest x-ray
Investigations to consider
- CT chest
- chest ultrasound
- bronchoscopy
Treatment algorithm
tension pneumothorax
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.
Differentials
- Asthma, acute exacerbation
- COPD, acute exacerbation
- Pulmonary embolism
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Pneumothorax
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