Snapshot 13-year-old child with cystic fibrosis presents to the emergency department with Staph aureus pneumonia. He suddenly develops increased respiratory distress, pleuritic chest pain, and decreased breath sounds in the right chest. Introduction Pneumothorax results from air in the pleural space that collapses lung tissue Leads to a ventilation/perfusion defect Etiologies include primary, spontaneous caused by rupture of the subpleural apical blebs usually in tall, thin males secondary caused by COPD, TB, trauma, pneumocystis pneumonia, S. aureus iatragenic causes thoracentesis subclavian lines mechanical ventilation bronchoscopy penetrating trauma non-penetrating trauma blunt trauma is most common cause severe coughing can also cause Presentation Symptoms sudden-onset, unilateral, pleuritic chest pain dyspnea acute respiratory distress Physical exam decreased or absent breath sounds hyperresonance on percussion tracheal deviation (usually in tension pneumothoraces) decreased or absent tactile fremitus Evaluation CXR diagnostic gold standard best observed in upright, end-expiration films will show collapsed lung may show broken ribs or other signs of associated trauma Differential Primary spontaneous pneumothorax, secondary pneumothorax, tension pneumothorax, acute asthma, inhalation of foreign object, myocardial infarction, panic attack Treatment Non-operative small pneumothoraces may reabsorb spontaneously Operative large and/or tension pneumothoraces may require immediate needle decompression chest tube placement following decompression pleurodesis injection of irritant into pleural space helps scar the two pleural layers together preventing recurrence and pleural effusion Prognosis, Prevention, and Complications Prognosis varies greatly depending on size, severity, and type of pneumothorax Prevention no preventive measures can be taken, though early intervention may slow progression from less to more serious symptoms Complications tension pneumothoraces may lead to shock and death if untreated