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Primary spontaneous pneumothorax — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPrimary spontaneous pneumothoraxSCE Acute Medicine

A 24-year-old tall non-smoking man presents with sudden left-sided pleuritic chest pain after playing football. He is comfortable at rest, oxygen saturation is 98% on air, respiratory rate is 18/min and blood pressure is 126/78 mmHg. Chest radiograph shows a 1.5 cm rim of air at the left apex with no mediastinal shift. What is the most appropriate next step in management?

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Correct answer: A — Discharge with safety-netting and early respiratory follow-up

This is a small, stable primary spontaneous pneumothorax in a patient without breathlessness, so conservative management with safety-netting is appropriate. Chest drain insertion would be excessive and exposes him to avoidable harm. Needle decompression is reserved for tension physiology. The key point is that physiological compromise, symptoms and pneumothorax size together determine intervention.

Reference: BTS Pleural Disease Guideline 2023