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Updated: Aug 3, 2026
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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Current management of spontaneous pneumothorax
P E Van Schil1, J M Hendriks, M G De Maeseneer
1Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem (Antwerp), Belgium. paul.van.schil@uza.be
Summary
Primary spontaneous pneumothorax management involves observation or aspiration for initial episodes. Recurrent cases and secondary spontaneous pneumothorax, often linked to COPD, require more aggressive treatments like surgery or talc pleurodesis.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Medical Treatment
Background:
- Spontaneous pneumothorax (SP) is categorized as primary (no underlying lung disease) or secondary (often due to COPD).
- Current treatment guidelines lack Level A evidence due to limited large randomized controlled trials.
- SP management varies from non-invasive observation to invasive surgical procedures.
Purpose of the Study:
- To outline current treatment strategies for primary and secondary spontaneous pneumothorax.
- To discuss management options based on recurrence and patient risk stratification.
- To highlight the role of surgical interventions in refractory cases.
Main Methods:
- Review of existing literature and treatment guidelines for spontaneous pneumothorax.
- Classification of SP into primary and secondary types.
- Description of treatment modalities including observation, aspiration, video-assisted thoracic surgery (VATS), and talc pleurodesis.
Main Results:
- First episodes of primary SP (<20% lung collapse) are managed by observation; larger collapses (>20%) are treated with aspiration.
- Recurrent or persistent primary SP often necessitates invasive approaches like VATS for bleb resection and pleurectomy/abrasion.
- Secondary SP in COPD patients warrants aggressive management, including thoracic drainage and recurrence prevention via thoracoscopy/thoracotomy or talc instillation for high-risk individuals.
Conclusions:
- Treatment decisions for SP depend on classification (primary vs. secondary), episode recurrence, and patient operative risk.
- Video-assisted thoracic surgery offers effective treatment for lung and pleural pathology in recurrent primary SP.
- A tailored approach, considering operative risk, is crucial for managing secondary SP, with talc pleurodesis as a key option for high-risk patients.
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