Spontaneous pneumothorax in a 24-year-old female

Abstract

A 24-yr-old Caucasian female was evaluated in May, 2003 at the San Martino hospital, Genoa, Italy, for the presence of “sudden onset” chest pain and nonproductive cough. Past medical history was only characterised by the presence of frequent headaches. The patient had been playing competitive tennis from the age of 6–20 yrs and, after retirement from competitions, had been smoking cigarettes (0.5 pack·day−1) for the last 4 yrs. The patient was nulliparous and reported the use of oral contraceptive in the last 3 yrs. Any suggestion of respiratory symptoms, including cough, shortness of breath or physical limitations during exercise were denied. On admission, the patient had no dyspnoea, and physical examination demonstrated a slight decrease in breath sounds over the left hemithorax. Heart sounds were normal and there was no cyanosis, clubbing or oedema. The abdomen was nondistended, nontender, and without bruits, hepatosplenomagaly or masses. There were no focal neurological findings. The patient had normal body temperature with normal values of blood pressure, pulse and respirations and transcutaneous blood gas determination in room air showed normal arterial oxygen and carbon dioxide tension. A chest radiograph demonstrated the presence of a left-sided pneumothorax. Blood tests were within normal values. After successful chest drainage, the patient was discharged. After a period of 2 weeks, in June 2003, the patient was evaluated in the outpatient clinic at the G. Gaslini Institute, Genoa, Italy, complaining of a persistent mild pain on the left hemithorax. High-resolution computed tomography (HRCT) scans (figs 1a⇓ and b) and pulmonary function tests (fig. 3⇓; table 1⇓) were performed and a follow-up re-evaluation was planned after 6–7 months. The patient did not complain of any symptoms until mid-December 2003, when a sudden onset left-sided chest pain was again experienced along with mild dyspnoea, but a chest radiograph failed to demonstrate the …