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Secondary spontaneous pneumothorax — SCE Respiratory MCQ

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ModeratePleural DiseaseSecondary spontaneous pneumothoraxSCE Respiratory

A 71-year-old man with severe COPD presents with acute pleuritic pain and dyspnoea. RR is 32/min, SpO2 88% on air and CXR shows a right pneumothorax with a 3 cm interpleural distance at the hilum. He remains breathless after analgesia and controlled oxygen. What is the most appropriate management?

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Correct answer: C — Insert a small-bore intercostal chest drain

This is a symptomatic secondary spontaneous pneumothorax in a patient with COPD and significant size, so small-bore chest drain insertion is appropriate. Conservative outpatient management is unsafe because physiological reserve is limited and symptoms persist. Needle aspiration may be considered in selected cases, but this vignette favours definitive drainage with inpatient care.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/