What are the different types of pneumothorax?

From the Guidelines

Pneumothorax can be classified into primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP), with the distinction based on the presence or absence of underlying lung disease, as well as other types such as traumatic, tension, iatrogenic, and catamenial pneumothorax. According to the most recent guidelines from the British Thoracic Society 1, spontaneous pneumothoraces can be subclassified into PSP in the absence of suspected lung disease or SSP in patients with established underlying lung disease. This distinction is crucial as it reflects differences in current management and outcomes between the two patient groups.

Types of Pneumothorax

• Spontaneous pneumothorax, which is further divided into:
  • Primary spontaneous pneumothorax (PSP): occurs in individuals without underlying lung disease
  • Secondary spontaneous pneumothorax (SSP): occurs in individuals with pre-existing lung conditions
• Traumatic pneumothorax: results from chest injuries, either blunt or penetrating trauma
• Tension pneumothorax: a life-threatening emergency where air enters the pleural space but cannot escape
• Iatrogenic pneumothorax: occurs as a complication of medical procedures
• Catamenial pneumothorax: a rare type occurring in women during menstruation, often associated with endometriosis

The severity of pneumothorax is typically described based on the size of the pneumothorax, which can be small, moderate, or large, depending on the percentage of lung collapse. However, the size of the pneumothorax is no longer an indication for invasive management, as stated in the latest BTS guideline 1. Instead, the use of chest drains is mainly centered around patients with high-risk characteristics.

Key Considerations

• The management of pneumothorax has evolved, with a more personalized approach and greater patient choice, as indicated by the expanded evidence base 1.
• The distinction between PSP and SSP is important for management and outcomes, with patients older than 50 years of age and having a smoking history potentially responding differently to needle aspiration (NA) 1.
• Treatment approaches vary by type and severity, ranging from observation for small spontaneous pneumothoraces to immediate needle decompression for tension pneumothorax, followed by chest tube placement for most significant cases.

From the Research

Types of Pneumothorax

• Pneumothorax can be classified into different types, including:
  • Spontaneous pneumothorax: occurs without recognized lung disease or due to an underlying lung disease 2, 3, 4, 5
  • Traumatic pneumothorax: caused by physical trauma to the chest 2, 4, 6
  • Iatrogenic pneumothorax: caused by medical or surgical intervention, such as transthoracic needle aspiration 2, 3

Subtypes of Spontaneous Pneumothorax

• Primary spontaneous pneumothorax (PSP): occurs without recognized lung disease 2, 3, 4, 5
• Secondary spontaneous pneumothorax (SSP): occurs due to an underlying lung disease 2, 3, 4, 5

Other Types of Pneumothorax

• Tension pneumothorax: a life-threatening condition where air enters the pleural space and cannot escape, leading to increased pressure and potential death 4
• Recurrent pneumothorax: can occur in patients with a history of pneumothorax, and may require surgical intervention or pleurodesis 3, 6