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Large PSP Management — RACP Adult Medicine MCQ

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ModerateRespiratoryLarge PSP ManagementRACP Adult Medicine

A 45-year-old man presents with a large primary spontaneous pneumothorax (estimated >50% on CXR). He is symptomatic with dyspnoea and tachycardia (HR 110). SpO₂ is 93% on room air. This is his first episode. What is the most appropriate management?

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Correct answer: C — Intercostal chest drain (small-bore, 10-14 Fr)

Large symptomatic primary spontaneous pneumothorax per BTS/Australian guidelines should be managed with aspiration first. If aspiration fails (re-accumulates to >50% or remains symptomatic), a small-bore chest drain (10-14 Fr, Seldinger technique) is inserted. Large-bore drains are reserved for trauma/haemothorax. VATS is considered after 2nd ipsilateral episode.

Reference: eTG Respiratory – 2024 – Pneumothorax; BTS 2023 Pneumothorax