Primary spontaneous pneumothorax: Classification, treatment and prognostic factors

Primary spontaneous pneumothorax (PSP) occurs in patients with no obvious precipitating factor, and no clinically apparent underlying lung disease. PSP usually occurs in tall, thin young males. Smoking increases a healthy male's lifetime risk of developing a pneumothorax from 1 to 12%. The exact physio-pathological mechanisms that result in PSP remain unclear. Symptoms vary greatly depending on the volume of air in the pleural cavity, the degree of lung collapse, and the individual's underlying lung function. Patients commonly seek medical attention because of sudden onset unilateral pleuritic chest pain, which may be associated with varying degrees of dyspnea, depending on the size of the pneumothorax. On examination, chest expansion and breath sounds may be reduced, and percussion of the chest wall hyper-resonant on the affected side. Oxygen saturation may be reduced. A plain chest radiograph usually confirms the diagnosis of a pneumothorax. The estimated size of a pneumothorax is a key factor in determining the initial management. Both the British Thoracic Society (BTS) and American College of Chest Physician (ACCP) guidelines divide pneumothoraces into small or large depending on the degree of lung collapse. PSP treatment aims to eliminate intrapleural air, and should always be guided by the clinical presentation of the patient. The size of the pneumothorax, the risk of recurrence, the patient's profession, the persistence of air leak, and patient preference play a role in deciding the type of treatment. Management options include observation, simple aspiration, intercostal drain insertion, thoracoscopic pleurodesis, Video-Assisted Thoracic Surgery (VATS) or open surgery. © 2013 by Nova Science Publishers, Inc. All rights reserved.