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Internal Medicine›Condition·Updated Apr 17, 2026·v1

Pneumothorax

Pneumothorax is a common pleural disorder ranging from simple spontaneous air leaks to life-threatening tension physiology. Diagnosis is primarily radiographic, though ultrasound is superior in emergencies. Management prioritizes stability, with a trend toward conservative care for small leaks and surgical intervention for persistent or recurrent cases.

High Evidence174 references·655 words·3 min read·v1
pulmonologyemergency_medicinethoracic_surgerycritical_care

Quick Reference

RxDrug of choiceSupplemental Oxygen (increases absorption rate)
AltAlternativesSimple aspiration (16-18G cannula)
⊘AvoidAir travel (until 1-2 weeks post-resolution), Scuba diving (permanently unless pleurectomy performed)
DxTest of choiceUpright PA Chest X-ray (Standard); POCUS (Emergency/Trauma)
ScKey scoreBTS Criteria (Large = ≥2cm at hilum)
→When to referPersistent air leak >5 days, recurrent episodes, bilateral collapse, high-risk professions
Pneumothorax management is driven by clinical stability and size; tension pneumothorax requires immediate clinical diagnosis and needle decompression.
Pneumothorax is the accumulation of air within the [[pleural space]], leading to partial or complete lung collapse. It is broadly categorized into spontaneous (primary or secondary), traumatic, and iatrogenic types. Primary spontaneous pneumothorax (PSP) typically affects young, healthy individuals without known lung disease, while secondary spontaneous pneumothorax (SSP) occurs in the context of underlying pathology such as [[COPD]], [[cystic fibrosis]], or [[Birt-Hogg-Dubé syndrome]].

Overview and Recommendations

Background

  • •Define pneumothorax as the presence of air between the visceral and parietal pleura, which disrupts the negative pressure required for lung expansion and can lead to cardiovascular impairment.
  • •Distinguish between primary spontaneous pneumothorax (PSP), occurring in patients without overt lung disease (often tall, thin male smokers), and secondary spontaneous pneumothorax (SSP), which complicates existing conditions like , , or .
  • •Recognize the genetic risk associated with (BHDS), an autosomal dominant condition caused by FLCN gene mutations that leads to pulmonary cysts and a nearly 60% lifetime risk of spontaneous pneumothorax.
  • •Identify iatrogenic triggers, including CT-guided lung biopsies (up to 43% risk for small nodules), central line placement, and mechanical ventilation, which can cause barotrauma and rapid progression to tension physiology.
  • •Understand the 'buffalo chest' phenomenon, an iatrogenic or congenital communication between the two pleural cavities (often seen after repair) that allows a unilateral air leak to become a life-threatening bilateral pneumothorax.
  • •Differentiate simple pneumothorax from , where increasing intrapleural pressure shifts the mediastinum and compresses the vena cava, leading to decreased venous return and obstructive shock.

Evaluation

  • •Suspect pneumothorax in any patient presenting with sudden-onset pleuritic chest pain and dyspnea, particularly if symptoms began at rest or following a thoracic procedure.
  • •Examine the patient for classic physical findings, including diminished or absent breath sounds on the affected side, hyper-resonance (tympany) on percussion, and decreased tactile fremitus.
  • •Monitor vital signs closely for 'red flags' of tension physiology: tachycardia, hypotension, SpO2 < 90%, and tracheal deviation away from the affected side.
  • •Obtain an upright posteroanterior (PA) chest X-ray as the first-line diagnostic study to identify the visceral pleural line and the absence of peripheral lung markings.
  • •Utilize point-of-care ultrasound (POCUS) in emergency or trauma settings to look for the 'lung point' sign (100% specific for pneumothorax) and the absence of 'lung sliding' or 'B-lines'.
  • •Measure the size of the pneumothorax using the British Thoracic Society (BTS) criteria (large = ≥2 cm rim of air at the level of the hilum) or the American College of Chest Physicians (ACCP) criteria (large = ≥3 cm at the apex).
  • •Identify the 'deep sulcus sign' on supine chest radiographs in trauma patients, characterized by an abnormally deep and radiolucent costophrenic angle.
  • •Rule out mimics such as giant pulmonary bullae, which typically have a concave inner border, and diaphragmatic hernia, which may show bowel loops in the thoracic cavity (pseudotension pneumothorax).
  • •Consider specialized imaging like MRI for suspected catamenial pneumothorax (related to ) if symptoms recur in sync with the menstrual cycle.
  • •Screen for underlying systemic diseases in patients with recurrent or bilateral episodes, including (LAM) in females or BHDS in those with a family history of renal tumors.

Management

  • •Administer supplemental oxygen (high-flow) to all patients requiring intervention, as this increases the rate of pleural air absorption by fourfold by reducing the partial pressure of nitrogen.
  • •Manage stable patients with a small PSP (<2 cm) conservatively with observation and a repeat chest X-ray in 6–24 hours; discharge is appropriate if the pneumothorax is stable and follow-up is guaranteed.
  • •Perform simple aspiration using a 16–18G cannula for large PSPs in stable patients; this is often better tolerated than chest tube insertion and may avoid hospitalization.
  • •Insert a small-bore chest tube (10–14 Fr) for patients with SSP, failed aspiration, or those who are symptomatic and unstable.
  • •Perform immediate needle decompression for suspected using a 14G needle in the 2nd intercostal space (midclavicular line) or the 4th/5th intercostal space (anterior axillary line) before waiting for imaging.
  • •Apply low-pressure negative suction (-20 cmH2O) if the lung fails to re-expand after 24–48 hours of water seal drainage or if a large air leak is present.
  • •Monitor for re-expansion pulmonary edema (RPE) when draining a lung that has been collapsed for >72 hours; avoid high-volume suction initially in these chronic cases.
  • •Consult thoracic surgery for a persistent air leak (PAL) lasting more than 5–7 days, or for recurrent, bilateral, or high-risk occupational (e.g., divers, pilots) pneumothoraces.
  • •Consider an autologous blood patch (50–100 mL of the patient's blood instilled via chest tube) or endobronchial valves for patients with PAL who are not candidates for surgery.
  • •Implement Respiratory Training-Based Rehabilitation (RTBR) post-procedure to improve FEV1 and reduce the duration of hospitalization.
  • •Remove the chest tube only after the air leak has ceased (no bubbling in the water seal) and the lung remains fully expanded on a trial of water seal for 4–24 hours.
  • •Advise patients to avoid air travel until at least 1–2 weeks after radiographic resolution has been confirmed, as hypobaric conditions can cause residual air to expand.
  • •Counsel all patients on permanent smoking cessation, as continued tobacco or cannabis use significantly increases the risk of recurrence.
  • •Refer patients with suspected genetic syndromes (e.g., BHDS) for genetic counseling and screening for associated visceral malignancies like renal cell carcinoma.

Board Review — High Yield

  • •Lung point — The most specific ultrasound sign for pneumothorax; represents the physical transition between collapsed and inflated lung.
  • •Deep sulcus sign — An abnormally deep, radiolucent costophrenic angle on a supine CXR, indicating pneumothorax in trauma patients.
  • •Birt-Hogg-Dubé syndrome — FLCN mutation; triad of spontaneous pneumothorax, fibrofolliculomas, and renal cell carcinoma.
  • •Catamenial pneumothorax — Recurrent pneumothorax occurring within 72 hours of menses onset; caused by thoracic endometriosis.
  • •Re-expansion pulmonary edema — A potential complication of rapid re-inflation of a lung that has been collapsed for more than 3 days.
  • •Buffalo chest — A rare condition where the pleural spaces communicate, leading to bilateral collapse from a single-sided air leak.
  • •Spiked helmet sign — An ECG pattern (ST-elevation with dome-and-spike) that can be seen in pneumothorax and mimics MI.
  • •Vaping-associated spontaneous pneumothorax (VASP) — An emerging entity in young patients using electronic cigarettes or cannabis concentrates.

Deep Dive — Evidence Details

References

  1. [1]

    Robbins MS, Kuruvilla D, Blumenfeld A et al.. “Trigger point injections for headache disorders: expert consensus methodology and narrative review.” Headache (2014). PMID: 25168295 ↗

    L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification
  2. [2]

    Donn SM. “Neonatal ventilators: how do they differ?” Journal of perinatology : official journal of the California Perinatal Association (2009). PMID: 19399015 ↗

    L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification
  3. [3]

    Wei MH, Blake PW, Shevchenko J et al.. “The folliculin mutation database: an online database of mutations associated with Birt-Hogg-Dubé syndrome.” Human mutation (2009). PMID: 19562744 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  4. [4]

    Welch BT, Eiken PW, Atwell TD et al.. “A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma.” Cardiovascular and interventional radiology (2017). PMID: 28138725 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  5. [5]

    Thompson P, Johannigman J, Hudson AJ et al.. “Traumatic Tension Pneumothorax: A Tale of Two Pathologies.” Journal of special operations medicine : a peer reviewed journal for SOF medical professionals (2025). PMID: 39688900 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  6. [6]

    Sedlák V, Koblížek V, Šimek R. “[Ultrasound examination of the chest in the hands of the clinical physician].” Vnitrni lekarstvi (2018). PMID: 29303294 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  7. [7]

    Zhang Y, Wang Y, Wang J et al.. “The prevalence of spontaneous pneumothorax in patients with BHD syndrome: a systematic review and meta-analysis.” Orphanet journal of rare diseases (2025). PMID: 40336059 ↗

    L2aSR_OBSCited in: Epidemiology and Risk Factors
  8. [8]

    Skrzypczak PJ, Dobiecki T, Rozmiarek M et al.. “Comparison of 40% Glucose Solution and Autologous Blood Patch Pleurodesis for the Treatment of Postoperative Air Leak After Lung Resections: A Prospective Randomized Controlled Study.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2025). PMID: 41191623 ↗

    L1bRCTCited in: Epidemiology and Risk Factors, Landmark Trials and Key Evidence
  9. [9]

    Takamochi K, Endo M, Funai K et al.. “Randomized Multicenter Trial of -8 cm H2O vs -15 cm H2O Intrathoracic Pressure Digital Thoracic Drainage for Air Leaks After Anatomic Pulmonary Resection.” The Annals of thoracic surgery (2026). PMID: 40886755 ↗

    L1bRCTCited in: Epidemiology and Risk Factors, Landmark Trials and Key Evidence
  10. [10]

    Raza MZ, Iqbal B, Sundaralingam A et al.. “Which clinical factors are predictive of outcome in primary spontaneous pneumothorax management?” BMJ open respiratory research (2025). PMID: 40541275 ↗

    L1bRCTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Landmark Trials and Key Evidence
  11. [11]

    Agamennone M, Lena F, Donati F et al.. “Bilateral Pneumothorax After Minimally Invasive Repair of Pectus Excavatum: Report of a Rare Life-Threatening Complication.” The Thoracic and cardiovascular surgeon (2026). PMID: 40962257 ↗

    L2aSR_OBSCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, History and Physical Examination
  12. [12]

    Al-Taj M, Alsabbah A, Ma'ali T et al.. “Vaping-Associated Pneumothorax: A Systematic Review of Case Reports and Case Series.” Medicina (Kaunas, Lithuania) (2025). PMID: 40142348 ↗

    L2aSR_OBSCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  13. [13]

    Macharia-Nimietz EF, Mallaev M, Gecas P et al.. “Efficacy of Non-Powered Stapler in Lung Volume Reduction Surgery of Severe Lung Emphysema: A Prospective Randomized Single-Blinded Monocentric Study.” Interdisciplinary cardiovascular and thoracic surgery (2026). PMID: 41787969 ↗

    L1bRCTCited in: Epidemiology and Risk Factors, Landmark Trials and Key Evidence
  14. [14]

    Maxwell CM, Weksler B, Shahbahrami K et al.. “Optimal Suction Strategy After Pulmonary Resection Using a Digital Drainage System With a Single Blake Drain: A Randomized Study.” Innovations (Philadelphia, Pa.) (2025). PMID: 40745972 ↗

    L1bRCTCited in: Epidemiology and Risk Factors, Landmark Trials and Key Evidence
  15. [15]

    Jørgensen KH, Christensen TD, Titlestad IL et al.. “Risk Factors for Pneumothorax After Treatment With Endobronchial Valves: A Cohort Study.” Respirology (Carlton, Vic.) (2025). PMID: 40442057 ↗

    L2bCOHORTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  16. [16]

    Farronato A, Travaglia C, Ravasin A et al.. “Patients with coronavirus disease 2019 and spontaneous pneumothorax: a propensity-matched, multicentre case-control study.” Interdisciplinary cardiovascular and thoracic surgery (2025). PMID: 40139717 ↗

    L3bCASE_CONTROLCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  17. [17]

    Zhu ZY, Yun YQ, Li H et al.. “Subpleural injection of gelatin sponge particles to reduce pneumothorax incidence in CT-guided lung biopsies: a retrospective single-center case-control study.” BMC cancer (2025). PMID: 40122807 ↗

    L3bCASE_CONTROLCited in: Epidemiology and Risk Factors
  18. [18]

    Yang J, Mo X, Wu F et al.. “Analysis of the risk factors associated with complications following CT-guided percutaneous core needle biopsy of small pulmonary nodules (≤1.5 cm): A single-center retrospective study.” Medicine (2025). PMID: 41305684 ↗

    L2bCOHORTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  19. [19]

    Reiber M, Mormol J, Krech L et al.. “Not All Black and White: Is Routine Chest Radiography Following Rib Fractures Beneficial?” The Journal of surgical research (2026). PMID: 41719620 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  20. [20]

    Shacker M, Wang L, Chang L et al.. “Pleural space complications after lung transplantation.” The Journal of thoracic and cardiovascular surgery (2026). PMID: 41338447 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  21. [21]

    Kimachi T, Kowa H. “Pneumothorax During Mechanical Ventilation in Patients With Amyotrophic Lateral Sclerosis: Incidence, Risk Factors, and Impact on Survival.” Muscle & nerve (2026). PMID: 41287942 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, History and Physical Examination
  22. [22]

    Goh KJ, Lim MT, Chua BLW et al.. “Incidence and risk factors for re-expansion pulmonary oedema following medical thoracoscopy.” BMJ open respiratory research (2025). PMID: 41253402 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  23. [23]

    Adachi T, Omasa M, Takehara R et al.. “The Safety and Efficacy of Secondary Spontaneous Pneumothorax Surgery: Especially in Interstitial Lung Disease and Chronic Obstructive Pulmonary Disease.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2025). PMID: 41237316 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  24. [24]

    Aydin S, Aydin SK, Gursoy D et al.. “Factors Associated With Early Recurrence in Non-Surgically Managed Primary Spontaneous Pneumothorax.” World journal of surgery (2025). PMID: 40689755 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  25. [25]

    Zhao XH, Zhu SB, Li X et al.. “CT-Guided Lung Biopsy with Needle Embolization Using Gelatin Sponge Slurry to Prevent Pneumothorax and Pulmonary Hemorrhage: A Propensity Score Matching Controlled Study.” Academic radiology (2025). PMID: 40368714 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  26. [26]

    Dufraigne A, Bonjean P, Gergele L et al.. “Noninvasive ventilation in chest trauma-related acute respiratory failure related to chest trauma: Efficacy and risk of pneumothorax.” European journal of trauma and emergency surgery : official publication of the European Trauma Society (2025). PMID: 40366384 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  27. [27]

    Liu YW, Kao CN, Ho CC et al.. “Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study.” Respiratory research (2025). PMID: 40346647 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  28. [28]

    Mahajan AK, Collar N, Muldowney F et al.. “Incidence and outcomes for post-bronchoscopic lung volume reduction (BLVR) pneumothoraces stratified by target lobe treated.” Respiratory medicine (2025). PMID: 40339665 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  29. [29]

    Murgu S, Chen AC, Gilbert CR et al.. “A Prospective, Multicenter Evaluation of Safety and Diagnostic Outcomes With Robotic-Assisted Bronchoscopy: Results of the Transbronchial Biopsy Assisted by Robot Guidance in the Evaluation of Tumors of the Lung (TARGET) Trial.” Chest (2025). PMID: 40300665 ↗

    L5OTHERCited in: Epidemiology and Risk Factors, Guidelines and Resources
  30. [30]

    Ha X, Feng Z, Wu Y et al.. “Management for perioperative complications of diaphragmatic surgery in ovarian cancer at a Chinese tertiary cancer center.” Journal of gynecologic oncology (2025). PMID: 40275686 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  31. [31]

    Brönnimann MP, Barroso MC, Manser L et al.. “The role of gravitational effects and pre-puncture techniques in reducing pneumothorax during CT-guided lung biopsies.” La Radiologia medica (2025). PMID: 40232655 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  32. [32]

    Beiriger J, Molin N, Robinson J et al.. “The Need for Postoperative Chest X-Ray After Placement of Hypoglossal Nerve Stimulator.” The Laryngoscope (2025). PMID: 40059803 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  33. [33]

    Calandri M, Brino J, Yevich S et al.. “Multicenter external validation of a novel aggregated technique for percutaneous CT guided lung biopsy for multiple samplings: the ExtraPEARL study.” European radiology (2025). PMID: 40055230 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  34. [34]

    Nishikimi K, Tate S, Matsuoka A et al.. “Intra- and postoperative complications associated with diaphragmatic surgery for advanced ovarian cancer.” Journal of gynecologic oncology (2025). PMID: 40017162 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  35. [35]

    Wang R, Chen X, Xu S et al.. “Prevalence and recurrence rates of spontaneous pneumothorax in patients with diffuse cystic lung diseases in China.” Orphanet journal of rare diseases (2025). PMID: 39934870 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  36. [36]

    Sun M, Jiang H, Zhao L et al.. “Association between Pneumothorax and Neonatal Outcomes among Very Preterm Infants: A Multicenter Cohort Study.” Neonatology (2025). PMID: 40383120 ↗

    L2bCOHORTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors
  37. [37]

    Ahmad SJS, Degiannis JR, Head M et al.. “Meta-analysis of the optimal needle length and decompression site for tension pneumothorax and consensus recommendations on current ATLS and ETC guidelines.” World journal of emergency surgery : WJES (2025). PMID: 40383767 ↗

    L2aSR_OBSCited in: Etiology and Triggering Factors
  38. [38]

    Chen X, Ryu JH, Hu X. “Spontaneous pneumothorax-associated with genetic disorders.” Therapeutic advances in respiratory disease (2026). PMID: 41905781 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  39. [39]

    Zhou SQ, Luo F, Ran X et al.. “Nonlinear association between lung needle path CT attenuation values and postprocedural immediate pneumothorax following computed tomography-guided lung biopsy: a retrospective cohort study.” BMC pulmonary medicine (2024). PMID: 39543604 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors
  40. [40]

    Wang M, Jiao J, Liu J et al.. “Radiological features of paraquat-induced pulmonary fibrosis.” Clinical toxicology (Philadelphia, Pa.) (2025). PMID: 40874874 ↗

    L4CASE_REPORTCited in: Etiology and Triggering Factors
  41. [41]

    Holtmann JA, Kipfer B, Lehmann B et al.. “Iatrogenic STEMI in a male trauma patient due to coronary artery compression by a left sided chest tube.” The American journal of emergency medicine (2025). PMID: 39909802 ↗

    L4CASE_REPORTCited in: Etiology and Triggering Factors, Differential Diagnosis
  42. [42]

    Latifi A, Wang D, Backer ED et al.. “Pleural Manometry in Pneumothorax: Evaluating Tension Physiology and Predicting Outcomes.” Chest (2026). PMID: 41076067 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  43. [43]

    Xie L, Song L, Wang J et al.. “Think twice before diagnosing tension pneumothorax: a retrospective analysis of pseudotension pneumothorax.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2025). PMID: 40128160 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Differential Diagnosis
  44. [44]

    Brock JM, Dittrich SA, Eichhorn F et al.. “Lessons Learned: Risk Factors and Clinical Impact of Severe Pneumothorax After Endoscopic Lung Volume Reduction With Endobronchial Valves.” Chest (2025). PMID: 39521377 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  45. [45]

    Turan YB. “Risk factors affecting the development of pneumothorax in patients followed up in intensive care with a diagnosis of COVID-19.” BMC infectious diseases (2024). PMID: 39501177 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  46. [46]

    Bénard-Laribière A, Pambrun E, Kouzan S et al.. “Association of fluoroquinolones with the risk of spontaneous pneumothorax: nationwide case-time-control study.” Thorax (2025). PMID: 39393909 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  47. [47]

    Pulle MV, Puri HV, Kumar A. “Reframing spontaneous pneumothorax: A practical guide to the PLEX variant classification.” Asian cardiovascular & thoracic annals (2026). PMID: 41499289 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  48. [48]

    Griffiths E. “Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis.” Scandinavian journal of trauma, resuscitation and emergency medicine (2021). PMID: 34801070 ↗

    L2aSR_OBSCited in: History and Physical Examination
  49. [49]

    Schubert AK, Dinges HC, Wulf H et al.. “Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery: A systematic review and meta-analysis.” European journal of anaesthesiology (2019). PMID: 31045699 ↗

    L2aSR_OBSCited in: History and Physical Examination
  50. [50]

    Kim S, Bae CM, Do YW et al.. “Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery.” The Thoracic and cardiovascular surgeon (2021). PMID: 32222960 ↗

    L1bRCTCited in: History and Physical Examination
  51. [51]

    Jouneau S, Ricard JD, Seguin-Givelet A et al.. “SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax: Endorsed by the French Speaking Society of Respiratory Diseases (SPLF), the French Society of Emergency Medicine (SFMU), the French Intensive Care Society (SRLF), the French Society of Anesthesia & Intensive Care Medicine (SFAR) and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV).” Respiratory medicine and research (2023). PMID: 37003203 ↗

    L1cGUIDELINECited in: History and Physical Examination, Landmark Trials and Key Evidence, Guidelines and Resources
  52. [52]

    Dridi D, Ottolini FL, Ambruoso D et al.. “Clinical features and management of thoracic endometriosis: a 20-year monocentric retrospective study.” Archives of gynecology and obstetrics (2025). PMID: 40158040 ↗

    L2bCOHORTCited in: History and Physical Examination
  53. [53]

    Park JS, Do YW, Park JM et al.. “Under-recognized primary spontaneous pneumothorax in ALS: a multicenter retrospective study.” Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2019). PMID: 31267304 ↗

    L2bCOHORTCited in: History and Physical Examination
  54. [54]

    Miró Ò, Llorens P, Jiménez S et al.. “Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study.” Chest (2021). PMID: 33227276 ↗

    L3bCASE_CONTROLCited in: History and Physical Examination
  55. [55]

    Lin YJ, Chen GX, Zhang Y. “Postoperative management of spontaneous pneumothorax in arthroscopic shoulder superior capsular reconstruction: A case report and review of literature.” Chinese journal of traumatology = Zhonghua chuang shang za zhi (2022). PMID: 35440401 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  56. [56]

    Chuah JS, Raymond Lim ZM, Lee EP et al.. “Emergency repair of blunt traumatic bronchus injury presenting with massive air leak.” Chinese journal of traumatology = Zhonghua chuang shang za zhi (2022). PMID: 35031204 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  57. [57]

    Delhez Q, Bairy L, Mitchell J et al.. “Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material.” BMC anesthesiology (2024). PMID: 38166574 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  58. [58]

    González-Pacheco H, Gopar-Nieto R, Jiménez-Rodríguez GM et al.. “Bilateral spontaneous pneumothorax in SARS-CoV-2 infection: A very rare, life-threatening complication.” The American journal of emergency medicine (2021). PMID: 32712235 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  59. [59]

    Spiro JE, Sisovic S, Ockert B et al.. “Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report.” Infection (2020). PMID: 32557347 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  60. [60]

    Ghisalberti M, Guerrera F, De Vico A et al.. “Age and Clinical Presentation for Primary Spontaneous Pneumothorax.” Heart, lung & circulation (2020). PMID: 32718900 ↗

    L5REVIEW_NARRATIVECited in: History and Physical Examination
  61. [61]

    Srinivas S, Lutz C, Rachwal B et al.. “Management Patterns and Outcomes of Children With Traumatic Occult Pneumothorax.” The Journal of surgical research (2026). PMID: 41832880 ↗

    L5OTHERCited in: History and Physical Examination
  62. [62]

    Occelli C, Lenoir M, Naudet Lasserre A et al.. “Prehospital diagnostic performance of emergency physicians in identifying blunt traumatic pneumothorax requiring early decompression.” BMC emergency medicine (2026). PMID: 41530696 ↗

    L5OTHERCited in: History and Physical Examination
  63. [63]

    Greene AC, Schaefer EW, Ziegler O et al.. “Surgical management patterns for spontaneous pneumothorax in adolescents and young adults.” Surgery (2025). PMID: 40907218 ↗

    L5OTHERCited in: History and Physical Examination
  64. [64]

    Benhaïm E, Roth B, Michel F et al.. “Management of primary spontaneous pneumothorax in teenagers: An 11-year study.” Acta paediatrica (Oslo, Norway : 1992) (2022). PMID: 34923666 ↗

    L5OTHERCited in: History and Physical Examination
  65. [65]

    Nutbeam T, Fenwick R, Smith J et al.. “A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped.” Scandinavian journal of trauma, resuscitation and emergency medicine (2021). PMID: 33446210 ↗

    L5OTHERCited in: History and Physical Examination
  66. [66]

    Jeon HW, Kim YD, Sim SB. “Should We Consider the Resected Lung Volume in Primary Spontaneous Pneumothorax?” World journal of surgery (2020). PMID: 32328783 ↗

    L5OTHERCited in: History and Physical Examination
  67. [67]

    Huang HK, Huang YJ, Lin KH et al.. “Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax.” World journal of surgery (2020). PMID: 32040606 ↗

    L5OTHERCited in: History and Physical Examination
  68. [68]

    Ziegler B, Kenngott T, Fischer S et al.. “Early hypothermia as risk factor in severely burned patients: A retrospective outcome study.” Burns : journal of the International Society for Burn Injuries (2019). PMID: 31378620 ↗

    L5OTHERCited in: History and Physical Examination
  69. [69]

    Allain PA, Carella M, Agrafiotis AC et al.. “Comparison of several methods for pain management after video-assisted thoracic surgery for pneumothorax: an observational study.” BMC anesthesiology (2019). PMID: 31279330 ↗

    L5OTHERCited in: History and Physical Examination
  70. [70]

    Li Y, He K, Wu J et al.. “Delayed tension pneumothorax 2 days after shoulder arthroscopic rotator cuff repair: a case report.” BMC musculoskeletal disorders (2025). PMID: 40275225 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  71. [71]

    Ki S, Choi B, Cho SB et al.. “Unexpected Tension Pneumothorax Developed during Anesthetic Induction Aggravated by Positive Pressure Ventilation: A Case Report.” Medicina (Kaunas, Lithuania) (2023). PMID: 37763751 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  72. [72]

    Kikutani K, Ohshimo S, Sadamori T et al.. “Regional respiratory sound abnormalities in pneumothorax and pleural effusion detected via respiratory sound visualization and quantification: case report.” Journal of clinical monitoring and computing (2022). PMID: 35147849 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  73. [73]

    Yamamoto H, Satomi K, Aizawa Y. “Electrocardiographic manifestations in a large right-sided pneumothorax.” BMC pulmonary medicine (2021). PMID: 33757495 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  74. [74]

    Ashcroft J, Murphy S, Laing TA et al.. “A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma.” Annals of the Royal College of Surgeons of England (2021). PMID: 33645284 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  75. [75]

    Goldman RD. “Spontaneous pneumothorax in children.” Canadian family physician Medecin de famille canadien (2020). PMID: 33077450 ↗

    L4CASE_REPORTCited in: History and Physical Examination
  76. [76]

    El Husseini K, Flament T, Laroumagne S et al.. “Mapping Bullous Emphysema With Lung Ultrasound: A Prospective Multicentre Study.” Respirology (Carlton, Vic.) (2025). PMID: 40059443 ↗

    L2bTRIAL_NONRANDOMCited in: Differential Diagnosis, Landmark Trials and Key Evidence
  77. [77]

    Xiao L, White D, Kruger LF et al.. “Thoracic endometriosis syndrome: imaging findings and the value of a dedicated MRI protocol.” Abdominal radiology (New York) (2025). PMID: 39964372 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  78. [78]

    Yamada A, Taiji R, Nishimoto Y et al.. “Pictorial Review of Pleural Disease: Multimodality Imaging and Differential Diagnosis.” Radiographics : a review publication of the Radiological Society of North America, Inc (2024). PMID: 38547031 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  79. [79]

    Carmo LHKD, Jaca LAM, Barreiros LMV et al.. “Challenges and strategies: treating spontaneous pneumothorax in massive pulmonary langerhans cell histiocytosis in children.” Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo (2024). PMID: 39630790 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  80. [80]

    Skopelidou V, Hurník P, Tulinský L et al.. “A unique case of AH-dominant type nodular pulmonary amyloidosis presenting as a spontaneous pneumothorax: a case report and review of the literature.” Pathology oncology research : POR (2023). PMID: 37808084 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  81. [81]

    Alhakeem A, Khan MM, Al Soub H et al.. “Case Report: COVID-19-Associated Bilateral Spontaneous Pneumothorax-A Literature Review.” The American journal of tropical medicine and hygiene (2020). PMID: 32666917 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  82. [82]

    Mahmoudi E, Hui JMH, Leung KSK et al.. “Spiked Helmet Electrocardiographic Sign-A Systematic Review of Case Reports.” Current problems in cardiology (2023). PMID: 36493916 ↗

    L2aSR_OBSCited in: Differential Diagnosis
  83. [83]

    Olgin GK, Ludwig C, Matthay MA et al.. “Pneumothoraces Associated With Vaping Cannabis Concentrate.” Pediatrics (2024). PMID: 39468959 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  84. [84]

    Phan T, Ricard C, Lee L et al.. “SPECT/CT with 99mTc-DTPA in a Patient with Persistent Complex Pneumothorax after Endobronchial Valve Placement.” Radiology. Cardiothoracic imaging (2024). PMID: 39115407 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  85. [85]

    Ye Y, Zhan Y. “Giant pulmonary bullae mistaken for pneumothorax.” The American journal of emergency medicine (2024). PMID: 39004543 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  86. [86]

    Rubin J, Chiu ML, Mino-Kenudson M et al.. “ARDS With Pneumothorax in a Young Adult.” Chest (2022). PMID: 35131063 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  87. [87]

    Kumar P, Skrabal J, Frasure SE et al.. “Pacemaker lead related myocardial perforation.” The American journal of emergency medicine (2022). PMID: 34511285 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  88. [88]

    Homer KL, Mandziuk J, Hirji A et al.. “Progressive Dyspnea With Recurrent Pneumothoraces.” Chest (2021). PMID: 34366047 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  89. [89]

    Hamad AM, Elmahrouk AF, Elmistekawy EM. “Respiratory Distress and Chest Pain in an Airplane Passenger With Radiolucent Left Hemithorax.” Chest (2021). PMID: 33965156 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  90. [90]

    Agrawal A, Karle E, Patel TP et al.. “A Pregnant Woman Presenting With Progressively Worsening Dyspnea and Pneumothorax.” Chest (2020). PMID: 32505325 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  91. [91]

    Sawan MA, Sayegh MN, Al Turk A et al.. “In-Acupuncture-induced Pneumothorax and Takotsubo Cardiomyopathy.” Interventional cardiology clinics (2026). PMID: 41276393 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  92. [92]

    Koh WH, Ko PJ, Su YT et al.. “Unmasking a hidden culprit: late-presenting congenital diaphragmatic hernia beyond infancy: A case report and literature review.” Medicine (2024). PMID: 38518042 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  93. [93]

    Ikejiri K, Goto H, Usui M et al.. “Septic pulmonary embolism and subsequent bilateral pneumothorax in patients undergoing chemoradiotherapy for head angiosarcoma: An autopsy case report and literature review.” Medicine (2022). PMID: 36397415 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  94. [94]

    Coppola MG, Lugarà M, Tamburrini S et al.. “Pneumomediastinum and Pneumothorax as Relevant Complications of Sub-Intensive Care of Patients with COVID-19: Description of a Case Series.” Medicina (Kaunas, Lithuania) (2021). PMID: 34577842 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  95. [95]

    Fukui T, Okubo T, Tanimoto N et al.. “Malignant pleural mesothelioma in a patient with pneumothorax: A cumbersome subtype both clinically and pathologically.” Thoracic cancer (2021). PMID: 33533198 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  96. [96]

    Marza AM, Petrica A, Buleu FN et al.. “Case Report: Massive Spontaneous Pneumothorax-A Rare Form of Presentation for Severe COVID-19 Pneumonia.” Medicina (Kaunas, Lithuania) (2021). PMID: 33498180 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  97. [97]

    Ha JH, Jeong BH. “Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report.” Medicina (Kaunas, Lithuania) (2021). PMID: 33430107 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  98. [98]

    Ferreira JG, Rapparini C, Gomes BM et al.. “Pneumothorax as a late complication of COVID-19.” Revista do Instituto de Medicina Tropical de Sao Paulo (2020). PMID: 32876299 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  99. [99]

    Alfehaid M, Salati SA. “Tension faecopneumothorax: an analysis of a rare complication of a missed diaphragmatic injury.” Polski przeglad chirurgiczny (2025). PMID: 41171116 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  100. [100]

    Leopizzi M, Cerbelli B, Merenda E et al.. “Mesenchymal cystic hamartoma presenting with pneumothorax: case report and review of the literature.” General thoracic and cardiovascular surgery (2020). PMID: 32361809 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  101. [101]

    Walker S, Hallifax R, Ricciardi S et al.. “Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax.” The European respiratory journal (2024). PMID: 38806203 ↗

    L1cGUIDELINECited in: Supportive Care and Complication Management, Guidelines and Resources
  102. [102]

    Walker S, Hallifax R, Ricciardi S et al.. “Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2024). PMID: 38804185 ↗

    L1cGUIDELINECited in: Supportive Care and Complication Management, Guidelines and Resources
  103. [103]

    Priyadarshi A, Gupta S, Priyadarshini P et al.. “Role of low-pressure negative pleural suction in patients with thoracic trauma - a randomized controlled trial.” European journal of trauma and emergency surgery : official publication of the European Trauma Society (2024). PMID: 38874624 ↗

    L1bRCTCited in: Supportive Care and Complication Management, Landmark Trials and Key Evidence
  104. [104]

    Damaraju V, Sehgal IS, Muthu V et al.. “Bronchial Valves for Persistent Air Leak: A Systematic Review and Meta-analysis.” Journal of bronchology & interventional pulmonology (2024). PMID: 38716831 ↗

    L2aSR_OBSCited in: Supportive Care and Complication Management
  105. [105]

    Kawaguchi Y, Hanaoka J, Hayashi K. “Feasibility of early removal of chest tube in the operating room for spontaneous pneumothorax: A prospective randomized controlled study.” Asian journal of surgery (2021). PMID: 32921545 ↗

    L1bRCTCited in: Supportive Care and Complication Management
  106. [106]

    Kedia Y, Madan M, Kaushik R et al.. “Thoracoscopic blood patch instillation for persistent air leak in pneumothorax: a case series and systematic review.” Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace (2025). PMID: 38656320 ↗

    L2aSR_OBSCited in: Supportive Care and Complication Management
  107. [107]

    Chen SY, Kuo YW, Ho CC et al.. “Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax.” BMC pulmonary medicine (2022). PMID: 35672758 ↗

    L2bTRIAL_NONRANDOMCited in: Supportive Care and Complication Management
  108. [108]

    Barton EC, Maskell NA, Walker SP. “Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions.” Seminars in respiratory and critical care medicine (2023). PMID: 37321247 ↗

    L5REVIEW_NARRATIVECited in: Supportive Care and Complication Management
  109. [109]

    Arakawa S, Matsudaira H, Noda Y et al.. “Catamenial pneumothorax with partial liver herniation due to diaphragmatic laceration: a case report and literature review.” Journal of cardiothoracic surgery (2021). PMID: 33731157 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  110. [110]

    Ahmed H, Badran A, Tamburrini A et al.. “Endobronchial Valves in the Management of Persistent Air Leak in Coronavirus Disease 2019.” The Annals of thoracic surgery (2022). PMID: 34492216 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  111. [111]

    Laohathai S, Wannadilok P, Poopipatpab S et al.. “Nonintubated Video-Assisted Thoracoscopic Surgery Using Local Anesthesia for Catamenial Pneumothorax.” The Annals of thoracic surgery (2021). PMID: 32971062 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  112. [112]

    Long B, Lacy AJ, Mason J et al.. “Tube Thoracostomy and Pleural Catheters: A Review for Emergency Clinicians.” The Journal of emergency medicine (2025). PMID: 40896901 ↗

    L5REVIEW_NARRATIVECited in: Supportive Care and Complication Management
  113. [113]

    Iqbal B, Hallifax R, Rahman NM. “Pneumothorax: An update on clinical spectrum, diagnosis and management.” Clinical medicine (London, England) (2025). PMID: 40374117 ↗

    L5REVIEW_NARRATIVECited in: Supportive Care and Complication Management
  114. [114]

    Saha BK, Chong WH, Hu K et al.. “Pressure-dependent persistent air leak in a patient with secondary spontaneous pneumothorax.” The American journal of the medical sciences (2022). PMID: 35787363 ↗

    L5REVIEW_NARRATIVECited in: Supportive Care and Complication Management
  115. [115]

    Wang J, Zhang Y, Li P et al.. “Effects of respiratory training combined with standard rehabilitation in patients with spontaneous pneumothorax undergoing VATS: A retrospective cohort study.” Medicine (2025). PMID: 41261666 ↗

    L2bCOHORTCited in: Supportive Care and Complication Management
  116. [116]

    Kahan AM, Kelley-Quon LI, Acker SN et al.. “Pleural drain placement following lung resection in children: A prospective observational study of the Western Pediatric Surgery Research Consortium.” Journal of pediatric surgery (2026). PMID: 40789464 ↗

    L5OTHERCited in: Supportive Care and Complication Management
  117. [117]

    van Steenwijk QCA, Spaans LN, Heineman DJ et al.. “Population-based study on surgical care for primary spontaneous pneumothorax.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2024). PMID: 38489837 ↗

    L5OTHERCited in: Supportive Care and Complication Management
  118. [118]

    Kagan S, Nahum E, Kaplan E et al.. “Persistent pulmonary air leak in the pediatric intensive care unit: Characteristics and outcomes.” Pediatric pulmonology (2021). PMID: 34048635 ↗

    L5OTHERCited in: Supportive Care and Complication Management
  119. [119]

    Pruitt LCC, Kastenberg ZJ, Fenton SJ et al.. “Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks.” Journal of pediatric surgery (2021). PMID: 33189301 ↗

    L5OTHERCited in: Supportive Care and Complication Management
  120. [120]

    Norris EA, McEvoy CS, Leatherman ML et al.. “Comparison of 10- versus 14-gauge angiocatheter for treatment of tension pneumothorax and tension-induced pulseless electrical activity with hemorrhagic shock: Bigger is still better.” The journal of trauma and acute care surgery (2020). PMID: 32366761 ↗

    L5OTHERCited in: Supportive Care and Complication Management
  121. [121]

    Martinez AF, Tom Z, Hsia DW et al.. “Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis.” Respiration; international review of thoracic diseases (2024). PMID: 38417419 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  122. [122]

    Zaghba N, Laklaai Z, Chaanoun K et al.. “Pulmonary edema ex vacuo after drainage of pyo-pneumothorax.” BMC pulmonary medicine (2023). PMID: 37974106 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  123. [123]

    Fiorelli A, Cannella L, Capasso F et al.. “One-way endobronchial valves in the management of complex persistent air leaks in a soft tissue sarcoma patient.” Thoracic cancer (2023). PMID: 37555456 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  124. [124]

    Uzunhan O, Yıldırım MB, Eser C et al.. “A rare cause of air-leak syndrome in a premature newborn: a case report.” BMC pediatrics (2023). PMID: 37442972 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  125. [125]

    Shaw JA, Wilken E, Allwood BW et al.. “Autologous Blood Patch Pleurodesis for the Management of a Persistent Air Leak after Secondary Spontaneous Pneumothorax.” Respiration; international review of thoracic diseases (2022). PMID: 34903699 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  126. [126]

    Keenan JC, Cho RC, Wong J et al.. “Utility of Functional Pneumonectomy by Using Intrabronchial Valves: First Case Series and Single Center Experience.” Journal of bronchology & interventional pulmonology (2022). PMID: 34879034 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  127. [127]

    Donatelli P, Trentacosti F, Pellegrino MR et al.. “Endobronchial valve positioning for alveolar-pleural fistula following ICU management complicating COVID-19 pneumonia.” BMC pulmonary medicine (2021). PMID: 34579700 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  128. [128]

    Komiya K, Hamanaka R, Shuto H et al.. “Re-expansion pulmonary edema following a pneumothorax drainage in a patient with COVID-19.” BMC pulmonary medicine (2021). PMID: 34530790 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  129. [129]

    Mak KL, Chan JWY, Lau RWH et al.. “Management of bronchopleural fistula with endobronchial valve in hybrid operating room following transbronchial microwave ablation.” Interactive cardiovascular and thoracic surgery (2021). PMID: 34245279 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  130. [130]

    Qu D, Chen N, Qiao DF et al.. “Rarely fatal bilateral re-expansion pulmonary edema after inserting a chest tube for unilateral spontaneous pneumothorax: a case report.” Forensic science, medicine, and pathology (2021). PMID: 33170459 ↗

    L4CASE_REPORTCited in: Supportive Care and Complication Management
  131. [131]

    Wang K, Zhou L, Zhu M et al.. “Medical Thoracoscopy With vs Without Prior Artificial Pneumothorax for Patients With Minimal or Absent Pleural Effusion.” Chest (2026). PMID: 40712947 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  132. [132]

    Arora D, Choudhary IS, Dutt A et al.. “Efficacy of slow negative pleural suction in thoracic trauma patients undergoing tube thoracostomy-A randomised clinical trial.” Injury (2025). PMID: 39393972 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  133. [133]

    Bian Y, Deng M, Gao Q et al.. “The Diagnostic Efficiency and Safety of Transbronchial Lung Cryobiopsy Using 1.1-mm Cryoprobe in Diagnosing Interstitial Lung Disease.” Lung (2024). PMID: 38910197 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  134. [134]

    Kaluarachchi DC, Gerday E, Bahr T et al.. “High vs low CPAP strategy with aerosolized calfactant in preterm infants with respiratory distress syndrome.” Journal of perinatology : official journal of the California Perinatal Association (2025). PMID: 38594414 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  135. [135]

    Li X, Yang H, Cai Y et al.. “Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial.” European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2024). PMID: 38479816 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  136. [136]

    Vitali F, Malagù M, Bianchi N et al.. “Ultrasound-Guided Venous Axillary Access Versus Standard Fluoroscopic Technique for Cardiac Lead Implantation: ZEROFLUOROAXI Randomized Trial.” JACC. Clinical electrophysiology (2024). PMID: 38243998 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  137. [137]

    Ravaglia C, Sultani F, Piciucchi S et al.. “Diagnostic yield and safety of transbronchial lung cryobiopsy for diffuse parenchymal lung diseases diagnosis: Comparison between 1.7-mm and 1.9-mm probes.” Pulmonology (2025). PMID: 37210342 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  138. [138]

    Marx T, Joly LM, Parmentier AL et al.. “Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial.” American journal of respiratory and critical care medicine (2023). PMID: 36693146 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  139. [139]

    Luengo-Fernandez R, Landeiro F, Hallifax R et al.. “Cost-effectiveness of ambulatory care management of primary spontaneous pneumothorax: an open-label, randomised controlled trial.” Thorax (2022). PMID: 35354647 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  140. [140]

    Ren Y, Zhu X, Yan H et al.. “Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: a randomized controlled study.” BMC anesthesiology (2022). PMID: 35321653 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  141. [141]

    Dheur S, Gérard L, Lamborelle P et al.. “Track Sealing in CT-Guided Lung Biopsy Using Gelatin Sponge Slurry versus Saline in Reducing Postbiopsy Pneumothorax: A Prospective Randomized Study.” Journal of vascular and interventional radiology : JVIR (2024). PMID: 39074550 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  142. [142]

    Sabzevari F, Eslamian M, Karami Robati F et al.. “Comparison of the efficacy of two natural surfactants (BERAKSURF and BLES) in the treatment of respiratory distress syndrome among preterm neonates.” BMC pediatrics (2023). PMID: 38036980 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  143. [143]

    Zuo C, Xue K, Yang H et al.. “Clinical Application of Confocal Laser Endomircoscopy Combined with Cryobiopsy in the Diagnosis of Interstitial Lung Disease.” Respiration; international review of thoracic diseases (2023). PMID: 37757757 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  144. [144]

    Zhang YS, Zhang SL, Guo WM et al.. “Clinical Effect of Modified Ultrasound-Guided Subclavian Vein Puncture.” International journal of clinical practice (2023). PMID: 37457808 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  145. [145]

    Yang F, Wang X, Xu H et al.. “A novel drainage strategy using chest tube plus pleural catheter in uniportal upper lobectomy: A randomized controlled trial.” Thoracic cancer (2023). PMID: 36562112 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  146. [146]

    Herath S, Wong C, Dawkins P et al.. “Cryobiopsy with radial-endobronchial ultrasound (Cryo-Radial) has comparable diagnostic yield with higher safety in comparison to computed tomography-guided transthoracic biopsy for peripheral pulmonary lesions: An exploratory randomised study.” Internal medicine journal (2023). PMID: 35675149 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  147. [147]

    Harrison M. “Non-Invasive Management of Blunt Traumatic Pneumothorax-a Meta-Analysis.” Emergency medicine Australasia : EMA (2025). PMID: 41163445 ↗

    L2aSR_OBSCited in: Landmark Trials and Key Evidence
  148. [148]

    Bosso G, Sansone G, Papillo M et al.. “Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP.” Journal of basic and clinical physiology and pharmacology (2023). PMID: 37463298 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  149. [149]

    Blythe NM, Coates K, Benger JR et al.. “Conservative management versus invasive management of significant traumatic pneumothoraces in the emergency department (the CoMiTED trial): a study protocol for a randomised non-inferiority trial.” BMJ open (2024). PMID: 38889939 ↗

    L2bTRIAL_NONRANDOMCited in: Landmark Trials and Key Evidence
  150. [150]

    Azat Azrai A, Mas Fazlin MJ, Nik Azuan I et al.. “Thoracic vent versus conventional intercostal tube drainage in management of pneumothorax in a tertiary referral centre.” The Medical journal of Malaysia (2025). PMID: 41328847 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  151. [151]

    Çıtak N, Özdemir S, Köse S. “Could the probability of surgical indication be determined after first episode of primary spontaneous pneumothorax?” General thoracic and cardiovascular surgery (2023). PMID: 36807111 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  152. [152]

    Sun YL, Sun L, Li TK et al.. “[Efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical resection of esophageal cancer using combined laparoscopic and thoracoscopic approach].” Zhonghua yi xue za zhi (2021). PMID: 34551495 ↗

    L1bRCTCited in: Landmark Trials and Key Evidence
  153. [153]

    Flume PA, Mogayzel PJ, Robinson KA et al.. “Cystic fibrosis pulmonary guidelines: pulmonary complications: hemoptysis and pneumothorax.” American journal of respiratory and critical care medicine (2010). PMID: 20675678 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  154. [154]

    Kelly AM. “Review of management of primary spontaneous pneumothorax: is the best evidence clearer 15 years on?” Emergency medicine Australasia : EMA (2007). PMID: 17655631 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  155. [155]

    Lee C, Revell M, Porter K et al.. “The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh.” Emergency medicine journal : EMJ (2007). PMID: 17351237 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  156. [156]

    Andrade Filho LO, de Campos JR, Haddad R. “[Pneumothorax].” Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia (2006). PMID: 17273626 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  157. [157]

    Frykholm P, Pikwer A, Hammarskjöld F et al.. “Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.” Acta anaesthesiologica Scandinavica (2014). PMID: 24593804 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  158. [158]

    van Dijk M, Sue R, Criner GJ et al.. “Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update.” Respiration; international review of thoracic diseases (2021). PMID: 34062550 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  159. [159]

    Schnell J, Beer M, Eggeling S et al.. “Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline.” Respiration; international review of thoracic diseases (2019). PMID: 30041191 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  160. [160]

    Agrafiotis AC, Assouad J, Lardinois I et al.. “Pneumothorax and Pregnancy: A Systematic Review of the Current Literature and Proposal of Treatment Recommendations.” The Thoracic and cardiovascular surgeon (2021). PMID: 32199405 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  161. [161]

    Rivas de Andrés JJ, Jiménez López MF, Molins López-Rodó L et al.. “[Guidelines for the diagnosis and treatment of spontaneous pneumothorax].” Archivos de bronconeumologia (2008). PMID: 18775256 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  162. [162]

    Schnell J, Beer M, Eggeling S et al.. “Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline.” Zentralblatt fur Chirurgie (2018). PMID: 30041262 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  163. [163]

    Aguinagalde B, Aranda JL, Busca P et al.. “SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax.” Cirugia espanola (2018). PMID: 29248330 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  164. [164]

    Sandig J, Bührer C, Czernik C. “[Lung Ultrasound in Neonatology to diagnose a Pneumothorax (part two): A Guideline].” Zeitschrift fur Geburtshilfe und Neonatologie (2021). PMID: 33352591 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  165. [165]

    Josephs LK, Coker RK, Thomas M. “Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.” Primary care respiratory journal : journal of the General Practice Airways Group (2013). PMID: 23732637 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  166. [166]

    Robinson PD, Blackburn C, Babl FE et al.. “Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.” Archives of disease in childhood (2015). PMID: 25670402 ↗

    L4CASE_REPORTCited in: Guidelines and Resources
  167. [167]

    Ng C, Tsung JW. “Point-of-care ultrasound for assisting in needle aspiration of spontaneous pneumothorax in the pediatric ED: a case series.” The American journal of emergency medicine (2014). PMID: 24360316 ↗

    L4CASE_REPORTCited in: Guidelines and Resources
  168. [168]

    Haynes D, Baumann MH. “Management of pneumothorax.” Seminars in respiratory and critical care medicine (2010). PMID: 21213209 ↗

    L5REVIEW_NARRATIVECited in: Guidelines and Resources
  169. [169]

    Wood DE, Cerfolio RJ, Gonzalez X et al.. “Bronchoscopic management of prolonged air leak.” Clinics in chest medicine (2010). PMID: 20172438 ↗

    L5REVIEW_NARRATIVECited in: Guidelines and Resources
  170. [170]

    Kelly AM, Druda D. “Comparison of size classification of primary spontaneous pneumothorax by three international guidelines: a case for international consensus?” Respiratory medicine (2008). PMID: 18789858 ↗

    L5OTHERCited in: Guidelines and Resources
  171. [171]

    Young LR, Almoosa KF, Pollock-Barziv S et al.. “Patient perspectives on management of pneumothorax in lymphangioleiomyomatosis.” Chest (2006). PMID: 16685018 ↗

    L5OTHERCited in: Guidelines and Resources
  172. [172]

    Hooper C, Maskell N. “British Thoracic Society national pleural procedures audit 2010.” Thorax (2011). PMID: 21474495 ↗

    L5OTHERCited in: Guidelines and Resources
  173. [173]

    Alan N, Farber SH, Zhou JJ et al.. “Incidence of radiographic and clinically significant pneumothorax or hemothorax after thoracic discectomy via mini-open lateral retropleural approach without prophylactic chest tube placement.” Journal of neurosurgery. Spine (2024). PMID: 38905710 ↗

    L5OTHERCited in: Guidelines and Resources
  174. [174]

    Nikolić MZ, Lok LS, Mattishent K et al.. “Noninterventional statistical comparison of BTS and CHEST guidelines for size and severity in primary pneumothorax.” The European respiratory journal (2015). PMID: 25792629 ↗

    L5OTHERCited in: Guidelines and Resources

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