Summary

Pneumothorax is air in the pleural space causing lung collapse. Primary spontaneous pneumothorax (PSP) occurs in healthy individuals (tall, thin young men, smokers). Secondary spontaneous pneumothorax (SSP) occurs in those with underlying lung disease (COPD, asthma, cystic fibrosis). Tension pneumothorax is a medical emergency requiring immediate decompression. Management follows BTS guidelines based on size, symptoms, and underlying lung disease. Treatment options include observation, needle aspiration, and chest drain.

Key Facts

• Definition: Air in pleural space with lung collapse
• Classification: Primary (healthy lung), Secondary (diseased lung), Traumatic, Tension
• Demographics: PSP: young males, tall, thin, smokers
• Gold Standard Investigation: CXR (or CT if uncertain)
• Emergency: Tension PTX - needle decompression + chest drain

Clinical Pearls

Size Pearl: Measure horizontal distance from lung edge to chest wall at hilum. Greater than 2cm = large (BTS).

SSP Pearl: All secondary pneumothoraces need intervention (aspiration or drain) - they tolerate lung collapse poorly.

Tension Pearl: Tension PTX is a CLINICAL diagnosis - don't wait for CXR. Needle decompress immediately.

Primary Spontaneous (PSP)

Secondary Spontaneous (SSP)

Tension Pneumothorax

• Emergency: Needle decompression (2nd intercostal space, midclavicular line)
• Followed by chest drain (5th intercostal space, anterior axillary line)