More details
Hide details
Associate Professor
Late Additional Professor
Professor and Head Department of Pulmonary Medicine, TN Medical College and BYL Nair Hospital, Mumbai, India
Corresponding author
Jyotsna M. Joshi   

Department of Pulmonary Medicine, OPD bldg, TN Medical College & BYL Nair Hospital, AL Nair Road, Mumbai Central, Mumbai - 400008, India
Pneumon 2019;32(4):144-154
Itardvin coined the term pneumothorax in the year 1803 and Laennec described its clinical features in 1819. It is defined as the presence of air or gas in the pleural cavity. Pneumothorax can be primary or secondary depending on underlying lung condition. This can be further classified as spontaneous, iatrogenic and traumatic. Primary spontaneous pneumothorax described by Kjaergard in 1932; occurs in people without underlying lung disease and in the absence of an inciting event. Secondary spontaneous pneumothorax (SSP) occurs in people with a wide variety of parenchymal lung diseases. Occasionally, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue leading to a tension pneumothorax and can present as a medical emergency. Symptoms are related to the amount of air present in the pleural cavity and underlying etiology. They typically include chest pain and shortness of breath. Diagnosis by physical examination alone can be difficult or inconclusive particularly in smaller pneumothoraces and X-ray chest or computed tomography (CT) scan is usually used to confirm its presence. Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. Larger pneumothoraces where patients are symptomatic needs intervention with simple needle aspiration, pigtail catheterization or intercostal drainage tubes.
MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010; 65(Suppl 2):ii18-ii31.
Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342:868-74.
Baumann MH. Non-Spontaneous Pneumothorax. In: Light RW, Lee YCG (eds).Textbook of Pleural Diseases. Arnold, London, 2003; 464–74.
Muramatsu T, Nishii T, Takeshita S, Ishimoto S, Morooka H, Shiono M. Preventing recurrence of spontaneous pneumothorax after thoracoscopic surgery: a review of recent results. Surg Today 2010; 40:696-9.
Light RW. Management of spontaneous pneumothorax. Am Rev Respir Dis 1993; 148:245-8.
Light RW. Pleural Diseases, 4th ed, Lippincott, Williams and Wilkins, Philadelphia, PA, 2001.
Noppen M, Baumann MH. Pathogenesis and treatment of primary spontaneous pneumothorax: an overview. Respiration 2003; 70:431–8.
Guo Y, Xie C, Rodriguez RM, Light RW. Factors related to recurrence of spontaneous pneumothorax. Respirology 2005; 10:378.
Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342:868–74.
Waseem M, Jones J, Brutus S, Munyak J, Kapoor R, Gernsheimer J. Giant bulla mimicking pneumothorax. J Emerg Med 2005; 29:155-8.
Light RW. Pneumothorax. In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. Philadelphia, WB Saunders, 1988; pp. 1745–59.
DeLassence A, Timsit JF, Tafflet M, et al. Pneumothorax in the intensive care unit: Incidence, risk factors, and outcome. Anesthesiology 2006;104:5-13.
Light RW. Pleural Diseases. 5th ed. Baltimore, Lippincott, Williams & Wilkins, 2007.
Saji H, Nakamura H, Tsuchida T, et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: The angle of the needle trajectory is a novel predictor. Chest 2002; 121:1521-6.
Singh N, Agarwal R. Bronchopleural fistula or alveolopleural fistula? Not just semantics. Chest 2006; 130:1948.
Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraete A. Quantification of the size of primary spontaneous pneumothorax: accuracy of the Lightindex. Respiration 2001; 68:396–9.
Baumann MH, Strange C, Heffner JE, et al. AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119:590–602.
Simon BC, Paolinetti L. Two cases where bedside ultrasound was able to distinguish pulmonary bleb from pneumothorax. J Emerg Med 2005;29:201-5.
Hoi K, Turchin B, Kelly AM. How accurate is the light index for estimating pneumothorax size? Austral Radiol 2007;51:196-8.
Phillips GD, Trotman-Dickensen B, Hodson ME, Geddes DM. Role of CT in the management of pneumothorax in patients with complex cystic lung disease. Chest 1997;112:275-8.
Mark JBD, McDougall IR. Diagnosis and localization of broncho pulmonary air leaks using ventilation scintigraphy. Chest 1997; 111:286-9.
Westeby S, Brayley N. Thoracic trauma (ABC of trauma). Br Med J 1990; 300:1639-94.
Wakai A, O'Sullivan R, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 2007; (1):CD004479.
Helmlich HJ. Helmilich valve for chest drainage. Med Instrm 1983; 17:29-31.
Joshi JM. Intercostal tube drainage of pleura: urosac as chest drainage bag. J Assoc Physicians India 1996; 44:381-2.
Sharma TN, Agnihotri SP, Jain NK, Madan A. Spontaneous pneumothorax: use of urosac as pneumosac. Ind J Tub 1987; 34:194-6.
Joshi JM. Ambulatory Chest Drainage. Indian J Chest Dis Allied Sci 2009; 51:225-31.
Rathinam S, Steyn RS. Management of complicated postoperative air-leak- a new indication for the Asherman chest seal. Interactive Cardiovascular and Thoracic Surgery 2007; 6:691-4.
Ong YE, Sheth A, Simmonds NJ, et al. Radiotherapy: a novel treatment for pneumothorax. Eur Respir J 2006;27:427-9.
Almind M, Lange P, Viskum K. Spontaneous pneumothorax: comparision of simple drainage, talc pleurodesis, and tetracycline pleurodesis. Thorax 1989;44:627-30.
Alfageme I, Moreno L, Huertas C, Vargas A, HrrnandezJ, Beiztegui A. Spontaneous pneumothorax: long term results with tetracycline pleurodesis. Chest 1994; 106:347-50.
Györik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed PN. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007; 29:757-60.
Yim APC, Ng CSH. Thoracoscopic management of spontaneous pneumothorax. Curr Opin Pulm Med 2001;7:210–4.
Kim SJ, Lee HS, Kim HS, et al. Outcome of Video-assisted Thoracoscopic Surgery for Spontaneous Secondary Pneumothorax. Korean J Thorac Cardiovasc Surg 2011; 44:225-8.
Journals System - logo
Scroll to top