A Case of Spontaneous Pneumothorax

A thin and young 25 years old man presents with sudden pain in the right lower chest and progressive dyspnoea. On examination cyanosis is present. BP is 100/70 mmHg and pulse is 100/min.

1. What is the most likely diagnosis?
2. How will you investigate this patient?
3. How will you manage this patient?

Question Solved:



1. What is the most likely diagnosis?

Answer: Primary Spontaneous Pneumothorax.

2. How will you investigate this patient?

Answer: Investigations:

• Chest X Ray PA view ( would most likely show mediastinal shift on the left and a collapsed lung with air in the pleural space on the right).
• Arterial Blood Gases 

3. How will you manage this patient?

Answer: As the patient in this case is symptomatic with dyspnoea and cyanosis as well as signs of shock (low BP and increased pulse) he needs immediate treatment:

• Give supplemental oxygen.
• Needle aspiration of air in the pleural space is done to reduce the size of the pneumothorax. 
• A chest tube insertion may be needed if needle aspiration does not work. ( usually inserted in an area under the axilla at a horizontal level with the nipple to avoid damage to other internal organs) 
• Followup with Repeat Chest X rays is done to determine the size of pneumothorax. if significant reduction has occurred the rest of the treatment can be conservative.