Abstract
Acute shortness of breath with chest discomfort is usually associated with sudden physiological changes, such as pneumothorax. Pneumothorax is the presence of gas in the pleural space. A spontaneous pneumothorax is one that occurs without antecedent trauma in healthy individuals.
A 19-year-old boy with no significant medical history was admitted to the emergency department (ED) with sudden onset of acute shortness of breath and right-sided chest pain. Chest films showed a right-sided pneumothorax, on the chest CT apical subpleural bullae was present so the diagnosis of Spontaneous Pneumothorax was established. Firstly drainage of the pleural cavity on the right side was performed but because of recurrence patient underwent thoracoscopic bleb resection (VATS) of the affected lung.
When spontaneous pneumothorax is diagnosed, it is important to differentiate between a primary and secondary cause, moreover CT scan is recommended to exclude presence of subpleural bullae and if necessary remove it to prevent recurrence.
References
1. Editors. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; 2018. P.76.
2. Berliner D, Schneider N, Welte T, Bauersachs J. The Differential Diagnosis of Dyspnea. Dtsch Arztebl Int. 2016;113(49):834-845. doi:10.3238/arztebl.2016.0834
Melton LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979 Dec;120(6):1379-82.
Warner BW, Bailey WW, Shipley RT. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax. Am J Surg. 1991;162(1):39-42.
Schwartz’s Principles of Surgery. Eleventh. McGraw-Hill; 2019. P.705-706.
Gorrochategui M, Ramsey, MD A, Niknejad M, et al. Pneumothorax. Reference article, Radiopaedia.org (Accessed on 11 Jan 2024) https://doi.org/10.53347/rID-4578
Mendogni P, Vannucci J, Ghisalberti M, et al. Epidemiology and management of primary spontaneous pneumothorax: a systematic review. Interact Cardiovasc Thorac Surg. 2020;30(3):337-345. doi:10.1093/icvts/ivz290
Chang J, Ratnaraj V, Fu V, et al. Pleural abrasion versus apical pleurectomy for primary spontaneous pneumothorax: a systematic review and Meta-analysis. J Cardiothorac Surg. 2023;18(1):105. Published 2023 Apr 6. doi:10.1186/s13019-023-02207-3
Lee JH, Kim R, Park CM. Chest Tube Drainage Versus Conservative Management as the Initial Treatment of Primary Spontaneous Pneumothorax: A Systematic Review and Meta-Analysis. J Clin Med. 2020;9(11):3456. Published 2020 Oct 27. doi:10.3390/jcm9113456