CLINICAL

• Pneumothorax (PTX) defined by air in pleural space, either due to entry from outside chest wall or leakage from lung parenchyma.
• In HIV, occurs most often in setting of Pneumocystis pneumonia (PCP). Spontaneous PTX in AIDS pt should prompt workup for PCP.
• PCP-associated PTX independently associated with greater mortality.
• Spontaneous PTX in pts with AIDS can also occur with TB, COPD, pulmonary cryptococcosis, coccidioidomycosis , and lymphoid interstitial pneumonitis.
• Iatrogenic causes: central venous line placement, thoracentesis, bronchoscopy, liver Bx
• Presenting Sx: pleuritic chest pain, dyspnea, cough
• PE: Tachycardia, tachypnea, hypoxia, hyper-resonance or decreased breath sounds over one lung field. Some pts may not have any signs or Sx beyond those of pneumonia.
• Higher incidence in males, cigarette smokers, pts on aerosolized pentamidine prophylaxis, pts w/ pneumatoceles on CXR, injection drug users, pts on mechanical ventilation.