Khanh, a 19-year-old who neither smokes nor has underlying health conditions, was admitted to the hospital with sharp pain in his left chest and difficulty breathing. Dr. Phan Tuan Trong from the Emergency Department at Tam Anh General Hospital, TP HCM, noted that Khanh's left lung had almost completely collapsed, with air and fluid in the pleural space, and lung markings nearly absent.

Doctors diagnosed Khanh with primary spontaneous pneumothorax, a condition where air suddenly appears in the pleural space in individuals without pre-existing lung disease or obvious trauma.

Khanh's left lung, lacking normal lung markings, retracted towards the hilum, forming a dense shadow. Photo: Tam Anh General Hospital

Normally, the lung adheres closely to the chest wall and expands with each breath. When air escapes from the lung and accumulates in the pleural space, it occupies the area, pushing the lung to contract towards the hilum. A large amount of air reduces the lung's ability to participate in respiration, causing the patient to experience shortness of breath.

Dr. Trong explained that the volume of air was so significant that Khanh's left lung was almost entirely collapsed, necessitating immediate decompression of the pleural space to allow the lung to re-expand. Continued air accumulation could increase intrathoracic pressure, further compressing the lung and diminishing its capacity for oxygen exchange.

The medical team inserted a chest tube. A small tube was placed through the chest wall into the left pleural space, connecting to a drainage system to provide an exit for the air and fluid compressing the lung. Upon activation of the system, air escaped under high pressure, allowing the lung to re-expand. Following drainage, Khanh's shortness of breath improved, and his pulse and blood pressure stabilized.

Doctors inserting a chest tube for Khanh. Photo: Tam Anh General Hospital

Khanh underwent a follow-up chest CT scan after the drainage procedure. The images revealed minimal residual air in the left pleural space, and with continued drainage, his left lung began to re-expand.

Primary spontaneous pneumothorax can affect young individuals, even those with no prior history of lung disease. Some cases are linked to the rupture of small air sacs, or blebs, in the periphery of the lung, causing air to leak into the pleural space. However, a specific structural cause is not always identifiable through imaging in every instance.

Dr. Trong advises that young people experiencing sudden chest pain accompanied by shortness of breath should seek medical evaluation, even if they were previously in good health.

By Nhu Ngoc

*Patient's name has been changed