Gas within the pleural space is known as a pneumothorax - a deceptively simple definition for a condition that can range from an incidental radiographic finding to a rapidly fatal emergency. A spontaneous pneumothorax is that which occurs in the absence of an external event, and this presents the clinician with an immediate diagnostic and therapeutic challenge: why did this happen, and what must be done next?



Spontaneous pneumothorax has fascinated physicians since its earliest descriptions in the 19th century, yet it remains a condition that continues to surprise even experienced clinicians. From the young, otherwise healthy patient presenting with sudden pleuritic chest pain, to the patient with advanced underlying lung disease who decompensates dramatically, the spectrum is wide and the stakes are high. The underlying aetiology (whether primary or secondary, related to structural lung disease, infection, genetic predisposition, or occult pathology) directly determines both acute management and long-term outcomes, including the risk of recurrence.