Joel E. Gallant, M.D., M.P.H., Patrick R. Sosnay, M.D.


  • 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.

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Last updated: September 3, 2015