SPONTANEOUS:
Primary: no preceding event or lung dz; thin, young men
Secondary: underlying lung dz, eg COPD
Chest pain, dyspnea
Decreased breath sounds and chest movement
Ipsilateral hyperresonance to percussion
CXR: absent lung markings, visceral pleural line
Treatment:
Small (2cm or less): observe, oxygen
Large and stable: needle aspiration or chest tube
TENSION:
Life threatening
Often due to trauma or mechanical ventilation
Same as spontaneous, + hemodynamic instability, + tracheal deviation away from the affected side
CXR: same, + contralateral mediastinal shift; ipsilateral hemidiaphragm flattening
Treatment:
Urgent needle decompression or chest tube placement