Pneumothorax in a patient with COPD after blunt trauma

A 53‐year‐old man with a history of heavy tobacco use presented with shortness of breath. Eight days prior to his presentation he was diagnosed with multiple rib fractures after suffering an assault. Since then he had developed dyspnea and a nonproductive cough. A chest x‐ray revealed a large pneumothorax on the right with approximately 80% volume loss (arrow, Figure 1).

^{Figure 1}

Chest x‐ray showing large pneumothorax.

Tube thoracostomy was performed. Repeat chest x‐ray showed that the pneumothorax had resolved, revealing a consolidation likely caused by either reexpansion pulmonary edema1, 2 or, given its location in the superior segment of the right lower lobe, aspiration pneumonia (thin arrow, Figure 2). Also seen in the x‐ray is an old scar (thick arrow, Figure 2) and apical bullous changes with hyperinflated lungs suggestive of chronic obstructive pulmonary disease (COPD).

^{Figure 2}

Chest x‐ray after lung re‐expansion.

DISCUSSION

Pneumothorax is a common complication of blunt trauma and rib fractures.3 While the patient did not have a preceding diagnosis of COPD, his extensive smoking history and his radiographic changes are consistent with COPD, which is a risk factor for pneumothroax. Secondary pneumothorax is defined as pneumothorax that occurs as a complication of underlying lung disease and is most commonly associated with COPD,4 with rupturing of apical blebs as the proposed mechanism. This patient suffered a pneumothorax due to trauma, but given his COPD he is at increased risk for developing spontaneous pneumothorax in the future.