Primary spontaneous pneumothorax: a pathway to practice
Primary spontaneous pneumothorax (PSP) commonly occurs in young, thin, tall males. The diagnosis and management of PSP can vary from institution to institution as well as by characteristics of the pneumothorax. Diagnostic work-up can include physical exam, chest X-ray, and/or chest CT scan. Therapeutic modalities range from observation, thoracentesis, tube thoracostomy ± pleurodesis, and/or surgical intervention. The practice variation in treatment of PSP may be due to uncertainty about the efficacy of each treatment modality. This review paper will discuss the pathophysiology of PSP as well as diagnostic and therapeutic modalities. The efficacy and risks of each therapeutic modality will be reviewed. Based on this information a proposed diagnostic and treatment algorithm for PSP is presented. Changes in management for first time versus recurrent PSP will also be explored. The authors provide a systematic review of the diagnostic and therapeutic management of PSP in order to assist clinicians in the management of these patients.