Decision

Decision Making in the Management of Secondary Spontaneous Pneumothorax in Patients with
Severe Emphysema
K. Robert Shen, MDa,*, Robert J. Cerfolio, MDb Spontaneous pneumothorax by definition is the
development of air in the pleural space between
the lung and the chest wall, which occurs without
any antecedent trauma or iatrogenic factors.
Traditionally, spontaneous pneumothorax is classified
further as primary or secondary. Although
there are some common features in terms of the
presentation, diagnosis, and management, this
subclassification recognizes that the two types of
spontaneous pneumothorax often are considered
and managed as distinct clinical entities. Primary
spontaneous pneumothoraces occur in persons
without clinically apparent lung disease.
Secondary spontaneous pneumothoraces occur
in those individuals who have known widespread
generalized lung disease causing chronic respiratory
symptoms, impaired pulmonary function,
and abnormalities on chest imaging. In contrast
to the clinical course of a primary spontaneous
pneumothorax, which is usually benign, secondary
spontaneous pneumothorax can be a potentially
life-threatening event because of the patients’
associated marginal pulmonary function and often
associated limited cardiopulmonary reserve.
Chronic obstructive pulmonary disease (COPD) is
the most common cause of secondary spontaneous
pneumothorax.1,2
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