Primary spontaneous pneumothorax: Review Article

Spontaneous rupture of blebs or bullae is commonly believed to be the primary mechanism leading to pneumothorax. However, several observations challenge this idea. First, it is unclear how often these lesions are pre-existing at the specific site of air leakage, with sites of lung rupture difficult to demonstrate during surgery or from resected lung tissue. Second, up to a quarter of patients with PSP do not demonstrate blebs or bullae on chest CT or during thoracoscopy. Third, blebs and bullae are detected in asymptomatic individuals on CT scan and thoracoscopy at rates ranging from 4% to 33%.