CXR Case 100

There is a large right sided pneumothorax.

No evidence of trauma.

The left lung looks congested but no obvious parenchymal disease.

With no known underlying lung disease this is a primary spontaneous pneumothorax (PSP; although the fact that a pneumothorax has occurred suggests underlying lung disease…).

Marijuana smoking is associated with the development of early bullous emphysema, although this is not apparent on the left side.

The size measurement of PSP is arbitrary

• the British guidelines suggest >2cm from chest wall to pleural edge at the level of the hilum
• the Americans suggest >3cm from apex to cupola.

Neither matter very much – the increasing evidence is that PSP can either be left completely alone and will resolve slowly, or simple aspiration using a 14G or 16G cannula is all that’s needed.

The absolute ‘size’ of the pneumothorax doesn’t really matter.. although if you feel the need to determine the exact volume, the most accurate means of assessment is with a CT scan.