Summary
Definition
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
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
Treatment algorithm
Contributors
Expert advisers
Amy Binnion, BSc (Biochemistry), MB BS, MRCP, PhD
Consultant Respiratory Physician
Respiratory Medicine Institution
Nottingham University Hospitals NHS Trust
Nottingham
UK
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
UK
Claire Vella MD, MRCP
Clinical Fellow Lung Cancer and Interventional Pulmonology
Glenfield Hospital
Leicester
UK
Onyeka Umerah
Respiratory Registrar
Glenfield Hospital
University Hospitals of Leicester NHS Trust
Leicester
UK
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
Jason Akulian, MD, MPH
Assistant Professor of Medicine
Director, Interventional Pulmonology
Carolina Center for Pleural Disease
University of North Carolina
Chapel Hill
NC
Disclosures
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.
Peer reviewers
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
Disclosures
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Asciak R, Bedawi EO, Bhatnagar R, et al. British Thoracic Society clinical statement on pleural procedures. Thorax. 2023 Jul;78(suppl 3):s43-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
Use of this content is subject to our disclaimer