Version May 2024
| Pneumothorax type | Specific diagnostic or management strategies to be considered |
| Primary spontaneous pneumothorax | Likely benign course with conservative management; drainage of pleural gas (typically aspiration), VATS for PAL; lower risk of recurrence. |
| Secondary spontaneous pneumothorax | PAL is more likely; early intervention with pleurodesis (blood, chemical, surgical) is typically needed; higher risk of recurrence. |
| COPD | Smoking cessation. |
| CF | May consider limited pleurodesis strategies if transplantation is planned. |
| Malignancy | Chemotherapeutic agents or radiation may be appropriate. Pneumothorax may not heal and PAL may be likely such that aggressive surgical strategies may fail. |
| Infection | Antimicrobials are warranted. Pneumothorax may not heal and PAL may be likely such that aggressive surgical strategies may fail. |
| Cystic lung disorders | Investigations or therapies targeted at suspected cause may be warranted (eg, lung biopsy, VEGF-D levels, folliculin gene analysis, rapamycin*). |
| Catamenial (endometriosis) | Hormonal therapy may be warranted. |
| Architectural abnormalities (eg, Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria) | May need specific investigations targeted at suspected cause (eg, homocysteine levels). |
| Iatrogenic | Likely benign course (unless patient is mechanically ventilated). Conservative management with drainage of air is usually sufficient. |
| Traumatic | May need to co-manage parenchymal trauma and other vascular and orthopedic aspects of chest trauma.¶ |
| Miscellaneous | |
| Anorexia | Nutrition needs to be addressed, PAL may be likely. |
| Exercise | Likely benign course and conservative management with drainage of air may be sufficient. |
| Illicit drug use | Cessation of drug use. |
| Immunosuppressant drugs | Cessation of offending agent, if feasible. |
| Air travel | Avoidance of air travel for short period after definitive management. |
| SCUBA diving | Avoidance of SCUBA diving for life. |
CF: cystic fibrosis; COPD: chronic obstructive pulmonary disease; PAL: prolonged (persistent) air leak; VATS: video-assisted thoracoscopic surgery; VEGF-D: vascular endothelial growth factor-D.
* Rapamycin, as an immunosuppressant, is a useful therapy for some patients with lymphangioleiomyomatosis, but should not be started until the pneumothorax has healed for about 6 weeks. Please refer to the UpToDate topics on sporadic lymphangioleiomyomatosis: clinical presentation and diagnostic evaluation and sporadic lymphangioleiomyomatosis: treatment and prognosis.
¶ A pneumothorax with tension physiology, although not limited to patients with trauma, requires immediate pleural decompression. Refer to UpToDate content for further details.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
