Spontaneous Pneumothorax in a Professional Soccer Goalkeeper in Chile: A Case Report

Abstract

Introduction: Primary spontaneous pneumothorax (PSP) is characterized by the accumulation of air in the pleural space without evident underlying lung disease. Its incidence is higher among young, tall, and slender men, with high-performance athletes being a risk group due to Valsalva maneuvers, sudden intrathoracic pressure changes, and repetitive thoracic microtrauma. Management ranges from observation to surgery, with recurrence as the main complication and early surgical intervention as the most effective strategy to reduce it.

Objective: To describe the clinical management, return-to-sport (RTS) program, and postoperative evolution of a 21-year-old Chilean professional goalkeeper with left-sided PSP treated surgically with apicectomy and talc pleurodesis via video-assisted thoracoscopic surgery (VATS).

Methods: Descriptive case report. The patient presented with sudden chest pain during the mobility phase of training, without trauma history. Initial evaluation revealed sinus tachycardia and an oxygen saturation of 95% on room air. Chest X-ray confirmed a moderate left pneumothorax (30%), later characterized by an apical subpleural bulla on computed tomography. Apicectomy and talc pleurodesis were performed by VATS, with favorable evolution and hospital discharge on the third day.

Results: The patient presented a moderate left pneumothorax (30%) with an apical bulla. The surgical intervention was successful, with hospital discharge on day 3 and no immediate complications. A four-phase RTS protocol was implemented, lasting a total of 62 days. Premature progression during phase 2 triggered symptoms that required plan adjustment. Final clearance was granted after completing all stages according to established milestones.

Conclusion: Early surgical management of PSP in a high‑performance athlete was associated with full functional recovery and return to competition in approximately eight weeks, without clinical recurrence during the first three months of follow‑up, although longer observation is required given the persistent risk of recurrence over time. The implementation of a supervised and structured RTS protocol, primarily guided by functional criteria and close clinical monitoring, allowed progressive and safe reintegration into competitive activity and may serve as a basis for future schemes in athletes with PSP. Regarding home ventilatory exercises, the use of a volumetric incentive spirometer was employed as a tool to organize and support adherence to deep‑breathing practice at home, but its role should be interpreted as complementary within the rehabilitation program, since current evidence has not consistently shown it to be superior to conventional respiratory physiotherapy.