spontaneous pneumothorax

Sometimes a lung springs a leak out of the blue, with no blow, no fall and no needle to blame. A spontaneous pneumothorax is a pneumothorax that happens on its own — most often because a small weak blister on the lung's surface quietly bursts and lets air escape into the pleural space.

Doctors split it into two patterns. The primary type strikes people with no known lung disease — classically tall, thin young men, often smokers — when a tiny apical air sac called a bleb ruptures. The secondary type occurs in people whose lungs are already damaged, such as those with COPD, asthma, cystic fibrosis or prior infection; because their lung reserve is poorer, even a modest collapse can be more dangerous.

The first episode is managed by size and symptoms, from watchful observation to aspiration or a chest tube. The bigger issue is recurrence: spontaneous pneumothorax has a real tendency to come back on the same side, so after repeated events, or in high-risk people, a procedure to fuse the pleural layers together (pleurodesis) is often offered to prevent another collapse.