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Persistent air leak — SCE Respiratory MCQ

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HardPleural DiseasePersistent air leakSCE Respiratory

A first primary spontaneous pneumothorax remains incompletely expanded with continuous bubbling despite a correctly positioned chest tube for six days. The patient is stable, but no bronchoscopic or surgical plan has yet been made. What is the most appropriate next step?

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

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Correct answer: C — Seek thoracic surgical advice for the persistent leak and incomplete re-expansion

Explanation lettering: B = shown as A · C = shown as B · A = shown as C

A is correct. BTS lists persistent air leak despite 5–7 days of chest-tube drainage, or failure of lung re-expansion, as an accepted indication for thoracic surgical advice; the older 3–5-day referral window is also discussed and each case remains individualised. Clamping or removing a visibly bubbling drain can precipitate recurrence or tension. Talc requires an appropriate pleural strategy and apposition, while waiting several further weeks delays consideration of VATS, repair, blood patch or endobronchial options in a patient who has already met the referral endpoint.

Reference: https://thorax.bmj.com/content/78/Suppl_3/s1