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Requests for reprints should be addressed to Daniel M. Lichtstein, MD, Professor of Medicine and Medical Education, Regional Dean for Medical Education, University of Miami Miller School of Medicine, Regional Medical Campus, 2500 N. Military Trail, Suite 260, Boca Raton, FL 33431.
A 44-year-old healthy male smoker presented with acute-onset sharp, left-sided chest
pain and mild dyspnea worsened by movement or deep inspiration. He denied prior episodes,
history of trauma, cough, palpitations, nausea, vomiting, or constitutional symptoms.
He is a current smoker with a 20-25 pack-year history. He has a comparably long history
of crack cocaine inhalation (no intravenous use) and alcohol use, which he attributes
to childhood exposure to drugs and violence, but had been abstinent for 2 months prior
to presentation. He continues to smoke cigarettes to reduce cravings for crack cocaine
or alcohol and participates in Alcoholics Anonymous. Physical examination demonstrated
normal body habitus and symmetric chest expansion without signs of trauma. Hyperresonance
to percussion and decreased breath sounds were noted in the left upper and middle
lung fields. The diagnosis of left-sided primary spontaneous pneumothorax was confirmed
with chest x-ray study (Figure, A) and noncontrast computed tomography (Figure, C and D). Due to the large-sized pneumothorax (50% collapse of the lung on computed
tomography) and concern for respiratory collapse, a chest tube was placed, and he
was admitted for observation. Repeat chest x-ray study 48 hours later revealed resolution
and the chest tube was removed (Figure, B). Prior to discharge, we counseled the patient on smoking cessation and its potential
to prevent recurrence.
Figure(A) Initial frontal upright chest radiography demonstrating left chest pneumothorax
in the range of 30% (arrows). (B) Frontal upright chest radiography after removal of the left pleural drain 48 hours
later demonstrates no pneumothorax. (C) Initial noncontrast computed tomography of the chest in the axial and (D) sagittal planes demonstrating a left-sided 50% pneumothorax (arrows) and no emphysematous
blebs or bullae.
Authorship: RH, NM, TP, AF, and ES participated in the care of this patient. ES drafted the manuscript and RH, NM, TP, AF, and DL assisted with revisions. All authors read and approved the final manuscript.
