A 26yo man presented to ED with increasing SOB on left side and chest pain. He has been a heavy
smoker for the past 4 years. He doesn’t have any past med hx. What is the likely dx?
a. Pulmonary embolism
b. MI
c. Asthma
d. Pleural effusion
e. Pneumothorax
answer: E
spontaneous pneumothorax (no history of trauma)
ƒ primary (no underlying lung disease)
Š spontaneous rupture of apical subpleural bleb of lung into pleural space
Š predominantly tall, healthy, young males
ƒ secondary (underlying lung disease)
Š rupture of subpleural bleb which migrates along bronchioalveolar sheath to the
mediastinum then to the intrapleural space
Š necrosis of lung tissue adjacent to pleural surface (e.g. pneumonia, abscess, PCP,
lung CA, emphysema)
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