VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

21 Spontaneous Pneumothorax in Healthy Young Adult

Scott McIntosh, DO; Aaron Keller, DO Corresponding author: Scott.mcintosh@hcahealthcare.com

LewisGale Hospital Montgomery Family Medicine Residency Program

clinic for sudden onset back and chest pain that developed two days prior while at rest sitting in his chair. The day after the initial occurrence he began to experience severe pain and chest pressure when he would walk and take deep breaths. When patient presented to the clinic he had continued pain any time he would walk and pain would resolve with rest. He reported that he runs several miles every week and has never experienced this pain before. Initial workup included physical exam with no abnormal findings, ECG which resulted as sinus bradycardia, and chest x-ray. It was initially believed his symptoms were musculoskeletal in nature and conservative treatment was advised prior to imaging results. The initial chest x-ray showed a small left apical pneumothorax. The patient was advised to go the ED for evaluation after which he was discharged home without any emergent treatment. He was advised against any flying, scuba diving, activity other than light walking and educated extensively on signs and symptoms of when to return to the clinic or the emergency department. He followed up in the outpatient clinic one week later and reported resolution of his symptoms. Repeat

chest x-ray at that time showed resolution of his pneumothorax. He was advised for a gradual return to normal activity over a span of 2 weeks and to return to clinic if he developed chest pain again. Discussion: Managing a primary spontaneous pneumothorax in the outpatient setting versus inpatient is a topic that is continually being evaluated and this case report provides evidence that it can be safely managed in the outpatient setting with associated imaging, follow up, activity restrictions, and appropriate guidance on when to return to normal activity.

Background: A primary spontaneous pneumothorax, or collapsed lung, by definition occurs in the absence of underlying clinical lung disease or precipitating factor. Although this is not a common occurrence, with one report stating the incidence of occurrence in males at about 7.4 per 100,000 population per year in the United States, it is a serious condition that primary care providers need to be able to properly diagnose and manage as it could potentially be life threatening and require emergent treatment. It can be difficult to diagnose due to symptoms, such as pain with breathing and moving or shortness of breath, which can be explained by more common causes such as musculoskeletal pain. With a stable patient outpatient management without any invasive procedures may be appropriate. This will require close monitoring of symptoms and appropriate step-wise return to activity level or sports once the pneumothorax has resolved on imaging. Signed consent was obtained for case report. Case Report: 19-year-old healthy, active, Caucasian male who presented to the outpatient

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