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Spontaneous Pneumothorax

Spontaneous pneumothorax is the presence of air within the pleural space causing
partial or complete collapse of the lung without preceding trauma

Also called

Spontaneous collapsed lung

ICD-10

J93

Specialty

Pulmonology

Onset

Acute

Reviewed

July 2026
On This Page

Overview

It is classified into:
• Primary spontaneous pneumothorax (PSP): Occurs in patients without clinically
apparent underlying lung disease.
• Secondary spontaneous pneumothorax (SSP): Occurs as a complication of underlying
lung disease.
• Recurrent pneumothorax refers to a second spontaneous episode (ipsilateral or
contralateral).

Etiology & Risk Factors

-Primary spontaneous pneumothorax :
• No clinically apparent underlying lung disease.
-Secondary spontaneous pneumothorax :
• Occurs due to underlying lung disease.
-Higher-risk patients :
• Age >50 years
• Smoking history
• Recurrent disease

Pathophysiology

• Air accumulates in the pleural space.
• Loss of negative intrapleural pressure leads to partial or complete lung collapse.
• Progressive accumulation of air may produce tension pneumothorax with
cardiorespiratory compromise.

Clinical Presentation

  • Clinical features vary depending on:
    • Size
    • Patient stability
    • Presence of underlying lung disease
    • Presence of tension physiology
    Patients are considered stable only if ALL of the following are present:
    • Respiratory rate <24/min
    • SpO₂ >90% on room air
    • Able to speak in complete sentences
    • Heart rate 60–120/min
    • Normal blood pressure
    Failure to meet any criterion indicates an unstable patient.
Spontaneous Pneumothorax Overview
Spontaneous Pneumothorax Overview

History Taking

  • Assess for:
    • Sudden onset symptoms
    • Previous spontaneous pneumothorax
    • Smoking history
    • Underlying lung disease
    • Recurrence
    • Symptoms suggesting respiratory compromise

Physical Examination

Assess:
• Respiratory rate
• Heart rate
• Blood pressure
• Oxygen saturation
• Ability to speak in full sentences
• Signs of respiratory distress
• Features suggesting tension pneumothorax

Investigations

  • Chest X-ray
    • Repeat chest X-ray after:
    • 3–6 hours for small stable primary spontaneous pneumothorax
    • Chest tube insertion
    -Assess The size using apex-to-cupola distance :
    • <3 cm Small
    • ≥3 cm Large

Diagnosis

  • Diagnosis is based on:
    • Clinical assessment
    • Chest imaging
    Tension pneumothorax remains a clinical diagnosis requiring immediate treatment.
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Management of Spontaneous Pneumothorax​

-Initial management for all patients :
• Continuous telemetry
• Continuous pulse oximetry
• Supplemental oxygen (if no risk factors for hypercapnia; target SpO₂ ≥96%)
• Avoid positive-pressure ventilation
• If mechanical ventilation is required, perform tube thoracostomy first


-Unstable patients :
• Immediate needle thoracostomy for suspected tension pneumothorax
• Follow immediately with chest tube placement
• Consider finger thoracostomy if needle decompression fails
• ICU transfer
• Thoracic surgery consultation

 

-Stable Primary Spontaneous Pneumothorax :
Small (<3 cm)
• Observation
• Repeat chest X-ray after 3–6 hours
• If stable/improving → consider outpatient management
• If enlarging → chest tube
Large (≥3 cm)
• Chest tube placement (small-bore catheter or chest tube)
• Needle aspiration may be considered
• Conservative management may be considered in carefully selected healthy patients
with:
• Initial episode
• No respiratory distress
• No progression on repeat imaging


-Stable Secondary Spontaneous Pneumothorax :
Small (<3 cm)
• Admission for monitoring
• Observation or chest tube placement
• Thoracic surgery consultation
Large (≥3 cm)
• Chest tube placement
• ICU consideration
• Thoracic surgery consultation

Complications of Spontaneous Pneumothorax​

• Recurrece
• Tension pneumothorax
• Cardiorespiratory compromise

Prognosis of Spontaneous Pneumothorax​

  • Depends on:
    • Primary vs secondary spontaneous pneumothorax
    • Pneumothorax size
    • Patient stability
    • Prompt recognition and management
    Small stable primary spontaneous pneumothoraces often resolve spontaneously within
    approximately 10 days

Key Points / Clinical Pearls of Spontaneous Pneumothorax​

  • • Air in pleural space causes lung collapse.
    • Primary = no clinically apparent lung disease.
    • Secondary = underlying lung disease.
    • Assess stability first.
    • Chest X-ray confirms diagnosis in stable patients.
    • Tension pneumothorax is a clinical diagnosis.