Which patient profile is most associated with spontaneous pneumothorax?

• A. Obesity
• B. Elderly with atrial fibrillation
• C. Tall, thin smoker
• D. Athlete with chest pain

Answer: (C)

Spontaneous pneumothorax is most strongly linked to tall, thin smokers because this body habitus predisposes to rupture of apical subpleural blebs. In tall individuals the apex of the lung experiences greater negative intrapleural pressure and greater mechanical stretch, which promotes bleb formation. If one of these blebs ruptures, air leaks into the pleural space and a pneumothorax develops. Smoking further increases the risk by promoting bleb formation and weakening lung tissue. This pattern describes primary spontaneous pneumothorax, typically in young to middle‑aged men with little or no underlying lung disease. Obesity is not a typical risk factor for this condition, while elderly patients with atrial fibrillation or athletes with chest pain point to other explanations or conditions.