State of the art: practical evaluation and management of pneumothorax

PURPOSE OF REVIEW: Pneumothorax is a common cause for hospital presentation. It can be divided into spontaneous and nonspontaneous subtypes depending on underlying mechanism. This review focuses on recent evidence, guidelines, and controversies relating to the assessment and management of spontaneous pneumothorax. RECENT FINDINGS: Advances in imaging and genetics have led to increasing recognition of structural, genetic, and hormone related causes of spontaneous pneumothorax. Many of these syndromes carry important extrapulmonary implications and require early diagnosis. Randomised data now support a conservative, symptom-guided approach in primary spontaneous pneumothorax. Persistent air leak in secondary spontaneous pneumothorax remains a challenging area especially in nonsurgical candidates, with available treatment options such as autologous blood patch therapy, pleurodesis, and endobronchial valves supported by limited high-quality evidence, leaving clinicians with little guidance in this heterogenous population. SUMMARY: Management of spontaneous pneumothorax has moved from a size-based interventional model towards a more individualised, symptom-guided approach. The future of pneumothorax care should focus on cost-effective screening for underlying aetiologies in PSP, understanding patient perspectives and priorities, improving understanding of disease mechanisms across different subgroups, and more robust evidence to guide optimal treatment strategies.