Secondary Pneumothoraces
Secondary spontaneous pneumothoraces are less common and account for approximately 10-20% of all spontaneous pneumothoraces.
The classic presentation would be that of a patient with COPD aged 60–70 years old. However, many other causes exist.
Other causes
Recognised causes of a secondary pneumothorax (This list is not considered comprehensive)
Obstructive airway disease
- Asthma
- COPD
Lung and pleural malignancy
Infection
- Pneumonia (particularly pneumocystis jiroveci [formerly PCP])
- TB
Suppurative lung disease
- Cystic Fibrosis
- Bronchiectasis
- Lung abscess
Interstitial lung disease
- Sarcoidosis
- Idiopathic Pulmonary Fibrosis
- Hypersensitivity pneumonitis
- Pneumoconiosis
Approximately 1-2% of HIV infected patients and 5-10% of patients with pneumocystis jiroveci (formerly PCP) develop a pneumothorax. With more effective treatment this incidence is falling.
Catamenial
A cause specific to women is catamenial pneumothorax.
A catamenial pneumothorax occurs at the time of (or within 72 hours of) menstruation.
The cause is endometriosis, which has been reported to account for approximately 5% of pneumothoraces in women [3].
Typically, the female patient will be aged 30-40 years old, the right lung will be affected (over 90% cases) and she will have been previously diagnosed with pelvic endometriosis (approximately one-third of cases). Half of these patients will have a recurrence of the pneumothorax in the following 12 months.
Hormonal treatment may improve the prognosis but given the high recurrence rate, referral for further investigation and consideration of surgery is warranted.