Case Report
Spontaneous pneumothorax resulting in tension physiology

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Abstract

Spontaneous pneumothorax (SP) is a relatively common pathology in emergency medicine; however, scant information is published regarding SPs developing tension physiology in the literature. Risk factors for spontaneous pneumothorax include smoking, family history, and underlying lung disease such as chronic obstructive lung disease (COPD), cystic fibrosis, tuberculosis, among others. Treatment often involves conservative management, needle aspiration, catheter placement, or tube thoracostomy. Tension pneumothorax, however, is a life threatening condition requiring emergent intervention. Case reports have demonstrated large SPs with midline shift but without tension physiology as patients largely remained hemodynamically stable. We report the case of an 18-year-old male presenting to the Emergency Department (ED) with a SP that rapidly developed tension physiology with mediastinal shift and hypotension resolved by needle decompression and CT placement.

Section snippets

Case report

An 18-year-old male with a past medical history of precordial catch syndrome and spontaneous left sided pneumothorax 1 year prior presented to the ED complaining of left sided chest pain and shortness of breath. The patient had a previous spontaneous left sided pneumothorax 1 year prior with no identifiable underlying etiology. He had no family history of alpha1-antitrypsin deficiency, Birt-Hogg-Dube syndrome, or any connective tissue disorders. Patient denied history of smoking or trauma, and

Discussion

A SP is an accumulation of air in the pleural space that is not the result of trauma or iatrogenic causes. The etiology of SP is contested but thought to be commonly the result of a ruptured subpleural bleb and is encountered frequently in emergency medicine with an incidence of 18–28 per 100,000 in males and 1.2–6.0 per 100,000 in females [1]. SPs can be either primary or secondary. Primary spontaneous pneumothoracies (PSPs) present in patients with no known underlying lung disease or inciting

Conflict of interests statement

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed

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