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Non-expandable lung — SCE Respiratory MCQ

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HardPleural DiseaseNon-expandable lungSCE Respiratory

A 74-year-old man with metastatic lung cancer has a pleural effusion drained via a small-bore catheter. He develops chest discomfort and the drain stops swinging after 1.2 L. CXR shows a persistent basal pneumothorax with failure of lung re-expansion and no air leak. What is the most likely diagnosis?

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Correct answer: A — Non-expandable lung due to visceral pleural restriction

A post-drainage pneumothorax without air leak and failure of lung re-expansion suggests pneumothorax ex vacuo from non-expandable lung. Tension pneumothorax would cause physiological compromise, while bronchopleural fistula usually produces persistent bubbling. Abdominal drain placement and PE would not explain this classic post-aspiration radiographic pattern.

Reference: BTS Pleural Disease Guideline 2023