Primary spontaneous pneumothorax due to high bleb burden

Primary spontaneous pneumothorax (PSP) occurs most frequently in young, tall, lean, male smokers without any known underlying lung disease. It is an important diagnosis to make promptly in order to prevent progression to obstructive shock. We present a case report of a young, male, former-smoker and polysubstance abuser with no prior lung history that developed acute dyspnea at rest and was found to have a large right pneumothorax on chest x-ray. A pig-tail catheter was utilized, but his course was complicated by a recurrent tension pneumothorax. Chest computed tomography (CT) revealed a significant bleb burden and the patient underwent a lung wedge resection with mechanical pleurodesis. What made our case unique were the chest x-rays revealing blebs that could have predicted the patient's recurrent pneumothorax as well as the multiple potential risk factors for developing blebs and a pneumothorax. All patients with recurrent PSPs and those with higher risk initial PSPs (e.g. blebs) should undergo preventive therapy with pleurodesis. We hope that clinicians can benefit from utilizing these representative chest x-ray images showing blebs.