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- 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.