Pneumothorax

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 25 Sep 2025

Last updated: 11 Jul 2024

Pneumothorax occurs when air gains access to, and accumulates in, the pleural space.

A pneumothorax is described as spontaneous when it occurs in the absence of trauma or medical intervention. A primary spontaneous pneumothorax occurs in young people without known respiratory illnesses. A secondary spontaneous pneumothorax occurs in patients with pre-existing pulmonary diseases.

A tension pneumothorax is a medical emergency that requires immediate decompression.

Patients with a pneumothorax typically report dyspnoea and chest pain. In tension pneumothorax, patients are distressed with rapid laboured respirations, cyanosis, profuse diaphoresis, tachycardia, and eventually shock.

First-line treatment of pneumothoraces depends on the clinical scenario and patient preferences. It may include observation with supplemental oxygen therapy, the use of an ambulatory device (where available), percutaneous aspiration of the air in the pleural space, insertion of a chest drain, and in some patients video-assisted thoracoscopy (VATS) or thoracostomy.

Patients with spontaneous pneumothoraces are at risk for recurrence. Pleurodesis (either by mechanical abrasion or by chemical irritation of pleural surfaces) can be used to limit the likelihood of recurrence, and multidisciplinary teams should be involved in decision-making.

Definition

Pneumothorax occurs when air gains access to, and accumulates in, the pleural space.

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

cough

Full details

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

Full details

Diagnostic investigations

1st investigations to order

chest x-ray
blood tests

Full details

Investigations to consider

chest ultrasound
CT chest
arterial blood gas (ABG)

Full details

Treatment algorithm

INITIAL

suspected tension pneumothorax

ACUTE

confirmed spontaneous pneumothorax

confirmed traumatic non-tension pneumothorax

confirmed pneumothorax ex vacuo

confirmed catamenial pneumothorax

ONGOING

acute pneumothorax resolved

persistent air leak

Contributors

Expert advisers

Amy Binnion, BSc (Biochemistry), MB BS, MRCP, PhD

Consultant Respiratory Physician

Respiratory Medicine Institution

Nottingham University Hospitals NHS Trust

Nottingham

Disclosures

.AB has attended a conference fully funded for all delegates by industry sponsorship from multiple sponsors.

Acknowledgements

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

Jonathan Bennett MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

Claire Vella MD, MRCP

Clinical Fellow Lung Cancer and Interventional Pulmonology

Glenfield Hospital

Leicester

Onyeka Umerah

Respiratory Registrar

Glenfield Hospital

University Hospitals of Leicester NHS Trust

Leicester

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

Jason Akulian, MD, MPH

Assistant Professor of Medicine

Director, Interventional Pulmonology

Carolina Center for Pleural Disease

University of North Carolina

Chapel Hill

Declarações

JB is deputy medical director of RCP Invited Service Reviews. CV declares that she has no competing interests. OU declares that she has no competing interests. 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.

Revisores

Matthew Knight, PGCertEd MD FRCP FRCP(Edin)

Associate Postgraduate Dean

Health Education England

Royal College of Physicians College Tutor

Consultant Respiratory Physician

Watford General Hospital

West Hertfordshire Hospitals NHS Trust

Declarações

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.

Créditos aos pareceristas

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Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Tschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J. 2015 Aug;46(2):321-35.Texto completo Resumo

Roberts ME, Rahman NM, Maskell NA, et al; BTS Pleural Guideline Development Group. British Thoracic Society guideline for pleural disease. Thorax. 2023 Jul;78(suppl 3):s1-s42.Texto completo Resumo

Asciak R, Bedawi EO, Bhatnagar R, et al. British Thoracic Society clinical statement on pleural procedures. Thorax. 2023 Jul;78(suppl 3):s43-68.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Asthma, acute exacerbation
- COPD, acute exacerbation
- Pulmonary embolism
Mais Diagnósticos diferenciais
Diretrizes
- British Thoracic Society guideline for pleural disease
- SPLF/SMFU/SRLF/SFAR/SFCTCV guidelines for the management of patients with primary spontaneous pneumothorax
Mais Diretrizes
Videos
Needle decompression of tension pneumothorax animated demonstration
Insertion of intercostal drain, Seldinger technique: animated demonstration
Mais vídeos
Folhetos informativos para os pacientes
Pneumothorax
Más Folhetos informativos para os pacientes
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Pneumothorax

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

suspected tension pneumothorax

confirmed spontaneous pneumothorax

confirmed traumatic non-tension pneumothorax

confirmed pneumothorax ex vacuo

confirmed catamenial pneumothorax

acute pneumothorax resolved

persistent air leak

Contributors

Expert advisers

Amy Binnion, BSc (Biochemistry), MB BS, MRCP, PhD

Disclosures

Acknowledgements

Declarações

Revisores

Matthew Knight, PGCertEd MD FRCP FRCP(Edin)

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Videos

Folhetos informativos para os pacientes

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice