skip to main content

Secondary Pneumothorax Management — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRespiratorySecondary Pneumothorax ManagementRACP Adult Medicine

A 62-year-old man with chronic obstructive pulmonary disease develops a spontaneous secondary pneumothorax. CXR shows a moderate right pneumothorax with visible rim of air >2 cm at the hilum. He has mild dyspnoea. SpO₂ is 92% on room air. What is the recommended management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intercostal drain (chest tube) insertion

Unlike primary spontaneous pneumothorax (which can be managed with aspiration or observation if small), secondary spontaneous pneumothorax (SSP – in patients with underlying lung disease like COPD) is managed more aggressively. BTS 2023 guidelines recommend intercostal drain (chest tube) insertion for all SSP with visible rim >2 cm or significant dyspnoea, as the underlying diseased lung has limited ability to re-expand and maintain expansion compared to healthy lungs. Small (<2 cm, minimal symptoms) SSP may be managed with aspiration but with a lower threshold for chest tube if aspiration fails.

Reference: eTG – 2025 – Respiratory; BTS – 2023 – Pneumothorax Guidelines