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Air in the pleural space.




Usually caused by a rupture of the pleura and can be sponatneous.

If left, the pneumothorax will fill the chest and crush the heart and lungs causing cardiorespiratory arrest. This is bad, kills people and makes this condition an emergency.

Risk Factors

Being a young, thin man.

Clinical Features


Medical Emergency - Tension pneumothorax is where an artificial valve means air can't get back out from in the pleural space e.g. a really quick and deadly pneumothorax. Same symptoms as below but really bad.

  • Respiratory - shortness of breath, pleuritic chest pain, diminished breath sounds and hyperesonant over affected area, reduced chest expansion
  • Cardiac - tachycardia, hypotension
  • Neck - deviated trachea, distended neck veins


Do an expiratory CXR (done whilst they've fully exhaled). Look for an area devoid of markings on the periphery of the collapsed lung.


Acute; primary pneumothorax

  • If no SOB, <2cm air on CXR - send home
  • If successful aspiration - send home
  • If successful repeat aspiration - send home
  • If not - chest drain

Acute; secondary pneumothorax

When the pneumothorax is caused by something else, then you need to do slightly different stuff.

  • If 'SOB AND >50y AND >2cm air on CXR - chest drain
  • Otherwise aspiration - succesful, admit for 24h
  • If unsuccessful aspiration - chest drain


Sometimes this may be necessary: bilateral; lung fails to expand after drain; 2 or more previous pneumothoraces on that side; or history of pneumothorax on same side.