Needle punctures, upper extremity block, infiltration associated to surgery.

Surgery related forces; diathermia in close proximity to the pleural space, any external force that may cause changes in the pleural pressures, e.g. shavers, profound pressure associated breast implant, reconstruction etc.

Anaesthesia-associated factors; any “accidental” high peak bronchial pressures e.g. caused by bronch intubation or use of a tube-exchange catheter, especially with continuous oxygen flow, and possibly enforced lung recruitment in a at risk patient.

Patient factors; smoking and lung disease, COPD/emphysema, lung cancer, history of pneumothorax, recent thoracic trauma.

Lung auscultation is not sufficient for identification of pneumothorax.