Approximately nine months later, a second pneumothorax occurred. Evaluation in the emergency room identified a recurrent left pneumothorax. The patient refused to have operation, then a chest tube was placed.

A third small left pneumothorax responded well to conservative management and no chest tube was required. The patient also refused to have operation.

The typical symptoms of spontaneous pneumothorax, regardless of cause, include pleuritic chest pain associated with dyspnea (4). Physical examination may show tachypnea, tachycardia, cyanosis, or ipsilateral decreased breath sounds.

Chest radiographs are required for definitive diagnosis. Ionizing radiation represents a potential risk to the fetus, particularly during the first 8 weeks of development. It is safe to proceed with the standard chest radiography without placing the fetus at substantial risk from ionizing radiation if the abdomen is shielded.

Treatment of pneumothorax during pregnancy is controversial. The use of prolonged intercostal drainage was considered as a temporizing measure for spontaneous pneumothorax in late pregnancy to be safe and effective. However, any vent i lator y problems assoc iated with pneumothorax may not be well tolerated by a pregnant patient and her fetus (5). So surgery is an option for persistent or recurrent pneumothorax despite adequate drainage. Recently, use of thoracoscopy has increased because the same procedures can be done through the thracoscope as with complete thoracotomy. The advantages of thoracoscopic surgical treatment over thoracotomy are decreased time of exposure to anesthetic drugs, rapid lung expansion, decreased postoperative pain, a potentially more brief postoperative period, and avoidance of a painful thoracotomy (6).