Secondary pneumothorax: Medical or surgical treatment?

Pneumothorax is defined as the presence of air in the pleural space. Classified into spontaneous, iatrogenic, traumatic and catamenial types, secondary pneumothorax (SPT) is distinguished by the presence of underlying pulmonary pathology. Initial management varies from simple oxygenation and monitoring to thoracic drainage, the decision depending on the patient’s clinical condition. Identification of the underlying cause is essential to guide treatment. The most common etiologies of PSS are pulmonary emphysema, particularly bullous emphysema, as well as infectious (such as those due to COVID-19 or tuberculosis) and neoplastic pathologies. Further treatment depends on the persistence of air leakage and radiological regression of the pneumothorax. Often, management is likened to a labyrinthine pathway involving medical treatment, bedside management and surgery. The decision, sometimes a delicate one, should be based on a number of criteria.