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Spontaneous Pneumothorax

Clinical Subject Page

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.

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.