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A Case of Recurrent Pneumothoraces

Case Editor - Judd Flesch

Reviewed By Clinical Problems Assembly

Submitted by

J. Shaun Smith, DO


Pulmonary and Critical Care Medicine

The Ohio State University

Columbus, Ohio

James N. Allen, MD

Professor of Medicine

The Ohio State University

Columbus, Ohio

Submit your comments to the author(s).


A 41-year-old female presents to pulmonary outpatient clinic with a history of right-sided pneumothorax, which had resolved.  She gives a history of several spontaneous pneumothoraces on her right side over the past 6 years.

She provides a past medical history of endometriosis and is being treated symptomatically with occasional over-the-counter medications.  She also has a history of right-sided pleural procedure after the second pneumothorax.  However, despite this surgical intervention, she continues to have recurrence of the pneumothorax.  Of note each pneumothorax resolved without intervention or complication.

Pulmonary function testing (PFT) was performed demonstrating a FEV1 of 86% predicted, total lung capacity (TLC) of 112 % predicted and diffusion capacity of 93 % predicted.  There was no significant response to bronchodilator challenge. Her remaining past medical history is significant for chronic low back pain from an L4-5 disc herniation, now status-post discectomy, chronic knee pain from osteoarthritis, and arthroscopic anterior cruciate ligament surgery.  Her only medications are nonprescription anti-inflammatories and a multivitamin.  She has never used tobacco or recreational drugs.  Family history is unremarkable.


Figure 1: An anteroposterior chest radiograph from last episode of pneumothorax.

Figure 2: High-resolution computed tomograph (HRCT) following resolution of a pneumothorax.

Question 1

What is the most likely diagnosis?


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