Sudden Onset Dyspnea; Are We in Danger of Being Ageist with Our Diagnostic Sieve?

Pneumothorax is a common presentation to both emergency and respiratory departments alike. Typically primary spontaneous pneumothorax (PSP) is taught as a disease of young, male patients with a mean age at presentation of approximately 30years. We present a case of an 87 year old patient presenting with her first pneumothorax. Detailed history, lung function and radiology confirmed this was not secondary to underlying lung disease but rather true PSP. The existence of PSP in the elderly is acknowledged, albeit rarely, to occur within previous epidemiological studies though we believe that our patient is the oldest person to feature in a published case report confirming this. Furthermore, our patient provides an important clinical lesson for respiratory diagnosticians as our admitting team, in the face of classical symptoms and signs, did not even consider pneumothorax as a possible diagnosis. Indeed, our patient provides a stark warning of inherent ageism blinding our diagnostic approach.