Referral to a Cardiothoracic Surgeon

The following criteria are accepted as indications for seeking a cardiothoracic opinion:

• Second ipsilateral pneumothorax
• First contra-lateral pneumothorax
• Bilateral spontaneous pneumothorax
• Persistent air leak or failure of lung re-expansion 5 days after chest drain insertion
• Spontaneous haemothorax
• Professions at risk (e.g. pilots, divers)
• Pregnancy

The risk of pneumothorax recurrence increases in pregnancy and conveys a significant risk to both mother and foetus.

Most air leaks will resolve after two weeks but the risk of infection of prolonged drainage may outweigh the low morbidity rate associated with surgical intervention, which has the added benefit of significantly reducing the future recurrence rate.

Learning bite

Recurrent pneumothorax
A second pneumothorax, whether ipsilateral or contralateral, is an indication for referral to a thoracic surgeon.