Pneumothorax type | Specific diagnostic or management strategies to be considered |
Primary spontaneous pneumothorax | Likely benign course with conservative management; drainage of pleural gas (typically aspiration), VATS for PAL; lower risk of recurrence. |
Secondary spontaneous pneumothorax | PAL is more likely; early intervention with pleurodesis (blood, chemical, surgical) is typically needed; higher risk of recurrence. |
COPD | Smoking cessation. |
CF | May consider limited pleurodesis strategies if transplantation is planned. |
Malignancy | Chemotherapeutic agents or radiation may be appropriate. Pneumothorax may not heal and PAL may be likely such that aggressive surgical strategies may fail. |
Infection | Antimicrobials are warranted. Pneumothorax may not heal and PAL may be likely such that aggressive surgical strategies may fail. |
Cystic lung disorders | Investigations or therapies targeted at suspected cause may be warranted (eg, lung biopsy, VEGF-D levels, folliculin gene analysis, rapamycin*). |
Catamenial (endometriosis) | Hormonal therapy may be warranted. |
Architectural abnormalities (eg, Marfan syndrome, Ehlers-Danlos syndrome, Homocystinuria) | May need specific investigations targeted at suspected cause (eg, homocysteine levels). |
Iatrogenic | Likely benign course (unless patient is mechanically ventilated). Conservative management with drainage of air is usually sufficient. |
Traumatic | May need to co-manage parenchymal trauma and other vascular and orthopedic aspects of chest trauma. |
Miscellaneous | |
Anorexia | Nutrition needs to be addressed, PAL may be likely. |
Exercise | Likely benign course and conservative management with drainage of air may be sufficient. |
Illicit drug use | Cessation of drug use. |
Immunosuppressant drugs | Cessation of offending agent, if feasible. |
Air travel | Avoidance of air travel for short period after definitive management. |
Scuba diving | Avoidance of scuba diving until definitive management. |