Secondary Pneumothoraces

The symptoms of a secondary spontaneous pneumothorax are often more severe than those associated with a primary pneumothorax because lung function may already have been compromised by the underlying pathological process.

The symptoms will vary depending on the cause. Still, the primary complaint is that of breathlessness which is often out of proportion to the size of the pneumothorax radiologically.

Unlike symptoms, the examination findings in primary spontaneous pneumothoraces are affected by the size of the pneumothorax. A small pneumothorax can be impossible to identify on clinical examination. If the pneumothorax is large, some of the features listed below may be present.

Possible clinical findings in a patient with a large spontaneous pneumothorax:

  • Tachycardia
  • Tachypnoea
  • Reduced breath sounds on the affected side
  • Reduced chest expansion on the affected
  • Hyper-resonance on the affected side
  • Decreased tactile/vocal fremitus on the affected side

The diagnosis is usually confirmed radiologically, following which specific information should be sought in order to guide management, advice and appropriate patient disposition/follow-up.

Patient information to guide management

Information required for planning management and follow up for a patient with a spontaneous pneumothorax*

  • Age of the patient
  • Does the patient feel breathless?
  • Determine if the pneumothorax is primary or secondary by reviewing the patient’s:
    • Past medical history and medication
    • History of presenting complaint (specifically ask about trauma)
    • Chest radiograph
  • History of previous pneumothorax (side, size and treatment)
  • Classify the size of the pneumothorax from the chest radiograph
    • <2 cm
    • >2 cm as measured from the lung margin to the chest wall at the level of the hilum or apex.
  • Duration of symptoms
  • Smoker (and how many cigarettes they smoke per day)
  • Family history of pneumothorax
  • Vocation
  • Plans for holidays/hobbies involving flying or SCUBA diving
  • Currently menstruating?

*This list is a guide and not considered comprehensive. Treatment may need to precede history if the patient is unstable.