A CASE REPORT OF

PRIMARY SPONTANEOUS PNEUMOTHORAX

Andrade Rosa, Inês 1; Lima, Marina 1; Valente, Cátia 1; Pacheco, Pedro 2
1 Resident in Family Medicine, USF Cova Da Piedade, Portugal | 2 Graduate Assistant in Family Medicine, USF Cova da Piedade, Portugal

BACKGROUNG

Primary spontaneous pneumothorax (PSP) occurs in patients without preexisting lung disease and no precipitating event.1
Risk factors include male gender, smoking, age under 40 years, ectomorph body type and family history of PSP.1
Acute chest pain and shortness of breath are the most frequent symptoms, however presentation can be highly variable.2
Pulmonary examination is utmost important to clinical diagnosis as it is a medical emergency that requires immediate intervention.1

METHODS

We present the case of a patient who consulted in our health unit. Complementary information was collected by researching databases
on this matter.

RESULTS

• Female, 22-years-old EMERGENCY DEPARTMENT

• Caucasian Additional imaging studies: extensive pneumothorax
• Profession: waitress
• Height 1,66m, Weight 53kg - Body mass index 19.2kg/m2
• Mild smoking habits (2 pack-years)
• No other relevant medical history

SUBJECTIVE
• Non-productive cough + sudden onset pleuritic pain (right side of the rib cage)
• No fever or dyspnea
• No apparent epidemiological context

OBJECTIVE
• Hemodynamically stable, eupneic, peripheral oxygen saturation 96%
• Pulmonary examination: auscultation with abolished breath sounds and
hyper-resonant percussion to the right hemithorax

ASSESSMENT
• R99 Respiratory disease other3 – right sided pneumothorax hypothesis Figure 1 – Thoracic computerized tomography scan from the ED

• Admitted for tube thoracostomy

PLAN
• Discharged 7 days later with complete pulmonary
• Reference to the emergency department (ED)
expansion

CONCLUSIONS

Family doctors are often the first medical contacts within health care, facing illnesses in an early stage4. The case described becomes of
relevance for exemplifying this setting, where sometimes undifferentiated and common symptoms may require urgent intervention.
It also reinforces the importance of physical examination, which can never be forgotten; in a time of progressive technological
development, complementary testing should never replace thorough clinical observation.

I declare I have not

BIBLIOGRAPHIC REFERENCES (1) BMJ Best Practice. Pneumothorax. Accessed on 25th February 2018. (2) Daley BJ. Pneumothorax. Medscape; 2017 [last received any
updated Dec 2017, accessed on 25th February 2018]. (3) ICPC-2. International Classification of Primary Care. Revised 2nd ed. WONCA International payment or
Classification Committee, Oxford University Press; 2005. (4) WONCA Europe. The European definition of general practice/family medicine. WONCA Europe services from a
2005 [Internet]. third party for the
submitted work.

Contact author: inesrosa11@gmail.com