Which of the following correctly describe a patient with spontaneous pneumothorax?

B. An unsuspected primary or metastatic lung tumor may be present.

E. Video-assisted thoracic surgery (VATS) should be considered for persistent air leak in patients with secondary spontaneous pneumothorax. 

DISCUSSION: A patient with spontaneous pneumothorax may be old and debilitated, but the typical patient is an otherwise healthy young adult, usually one who smokes. An incidental, unsuspected lung cancer is discovered on rare occasions when operation is performed to control a persistent air leak. Perhaps smoking is a common factor. Absorption of air from the pleural space can be facilitated by the administration of supplemental oxygen. Increasing the oxygen tension lowers the partial pressure of nitrogen (P N2) of the capillary blood and increases the partial pressure difference between the pleural space and the pulmonary capillary. If the pneumothorax results in less than 20% collapse of the lung an asymptomatic patient can be safely observed; however, a larger or persistent pneumothorax is best treated with an intercostal tube thoracostomy. Patients with bullous emphysema may require stapling of bullae and pleurectomy, which can be done by open thoracotomy or thoracoscopically (VATS).