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Primary spontaneous pneumothorax after failed aspiration — SCE Acute Medicine MCQ

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ModerateProcedural KnowledgePrimary spontaneous pneumothorax after failed aspirationSCE Acute Medicine

A 35-year-old tall man presents with sudden pleuritic chest pain. Chest radiograph shows a 3.5 cm left apical pneumothorax and he is comfortable at rest with SpO2 98% on air. Needle aspiration removes 2.1 L of air, but repeat imaging shows persistent 3 cm pneumothorax. He remains clinically stable. What is the most appropriate next step in management?

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Correct answer: D — Insert a small-bore chest drain with an underwater seal

Persistent sizeable pneumothorax after aspiration is an indication for small-bore chest drain insertion. Repeated aspiration after a large initial air volume is unlikely to succeed and risks delay. Discharge is inappropriate with a persistent 3 cm pneumothorax. The point is to match intervention to both physiology and failure of the first-line procedure.

Reference: BTS pleural disease guideline 2023