Secondary Spontaneous Pneumothorax in Asthma: A Dancing Gorilla Moment

This report describes how cognitive bias contributed to a delay in diagnosing secondary spontaneous pneumothorax in a patient with asthma. A female in her 70s with a past history of asthma presented with shortness of breath at rest and chest pain. She was treated for an acute asthma exacerbation but did not respond as expected. With failure to improve overnight, a review of the chest X-ray revealed a right-sided pneumothorax that had not been previously recognised. This case illustrates how clinicians' susceptibility to cognitive biases and perceptual errors can affect patient care. It highlights the importance of a systematic approach to interpreting imaging and considering an alternative diagnosis when patients respond poorly to conventional treatment.