Primary spontaneous pneumothorax

Primary Spontaneous Pneumothorax

Primary spontaneous pneumothorax (PSP) is a medical condition characterized by the sudden onset of a collapsed lung without any apparent cause or underlying lung disease. It is a type of pneumothorax, which refers to the presence of air in the pleural space, the area between the lung and the chest wall.

Pathophysiology

PSP occurs when small air blisters, known as blebs, on the surface of the lung rupture, allowing air to escape into the pleural space. This can lead to partial or complete lung collapse. The exact cause of bleb formation is not well understood, but it is believed to be related to genetic factors and structural abnormalities in the lung tissue.

Epidemiology

PSP is more common in young, tall, thin males, typically between the ages of 10 and 30. It is less common in females. The incidence rate is estimated to be around 7.4 to 18 cases per 100,000 population per year for males and 1.2 to 6 cases per 100,000 population per year for females.

Clinical Presentation

Patients with PSP often present with sudden onset of sharp, pleuritic chest pain and shortness of breath. The pain is usually localized to the affected side and may radiate to the shoulder or back. In some cases, the pneumothorax may be asymptomatic and discovered incidentally on a chest X-ray.

Diagnosis

The diagnosis of PSP is typically confirmed with a chest X-ray, which shows the presence of air in the pleural space and a visible visceral pleural line. In some cases, a CT scan may be used for further evaluation, especially if the diagnosis is uncertain or if there is suspicion of underlying lung disease.

Management

The management of PSP depends on the size of the pneumothorax and the severity of symptoms. Small, asymptomatic pneumothoraces may be managed conservatively with observation and follow-up. Larger or symptomatic pneumothoraces may require intervention, such as needle aspiration or chest tube insertion, to remove the air from the pleural space and allow the lung to re-expand.

Prognosis

The prognosis for PSP is generally good, with most patients recovering fully. However, there is a risk of recurrence, with rates ranging from 30% to 50% within the first few years after the initial episode. Preventive measures, such as smoking cessation and avoiding high-altitude activities, may help reduce the risk of recurrence.

See Also

• Pneumothorax
• Pleural space
• Chest tube

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NIH genetic and rare disease info

• NIH info on Primary spontaneous pneumothorax

Primary spontaneous pneumothorax is a rare disease.