A pneumothorax is a collection of air
outside the lung but within the pleural
It occurs when air accumulates
between the parietal and visceral
pleurae inside the chest.
The air accumulation can apply
pressure on the lung and make it
Air can enter the pleural space by two
mechanisms, either by trauma causing
communication through the chest wall
or from the lung by rupture of the
A primary spontaneous pneumothorax
(PSP) occurs automatically without a
known eliciting event, while a
pneumothorax (SSP) occurs after an
underlying pulmonary disease.
A traumatic pneumothorax can be the
result of blunt or penetrating trauma.
A simple pneumothorax does not shift
the mediastinal structures, as does a
Open pneumothorax is an open
wound in the chest wall through which
air moves in and out.
II. Rupture of emphysematous bulla.
III. Rupture of lung abscess or
tuberculosis lesion into pleural
a The chest radiography image shows a large lucency occupying the right upper thorax with mediastinal shift and
patchy opacities of the left apical area. b The coronal computed tomography image shows giant bullae occupying
the right thorax and multiple opacities over the left upper lung
Penetrating rib fracture
Accidental opening of pleural cavity
during abdominal surgery
Penetration of pleura during central
venous pressure catheter insertion.
The most common symptoms are:
Shortness of breath.
The chest pain is pleuritic, sharp,
severe, and radiates to the ipsilateral
On examination, the following findings are
Diminished chest movement
Absence of breath sound over apex of
Increased respiratory rate
Asymmetrical lung expansion
Decreased tactile fremitus
Hyper resonant percussion note
Decreased intensity of breath sounds or
absent breath sounds
In tension pneumothorax following
additional findings are seen:
Tachycardia of more than 134 beats
Jugular venous distension
A small pneumothorax requires few
days of bed rest until it resolves.
A large pneumothorax (›25 percent of
pleural space is filled with air) is
treated with needle aspiration or by an
Pleurodesis or pleurectomy may
indicated for recurrent pneumothorax.