A 45-year-old man with a large right-sided primary spontaneous pneumothorax (4 cm rim on CXR) is symptomatic with dyspnea. He has no underlying lung disease. What is the most appropriate initial management?
- A Observation with high-flow oxygen
- B Simple aspiration
- C Intercostal tube drainage (small-bore catheter) ✓
- D Video-assisted thoracoscopic surgery
Correct answer: C. Intercostal tube drainage (small-bore catheter)
Explanation
According to BTS guidelines, a large (>2 cm) primary spontaneous pneumothorax in a symptomatic patient warrants intercostal tube drainage. Simple aspiration is an alternative for moderate-sized PSP, but large symptomatic PSP with >4 cm rim is better managed with chest drain. Observation is only for small, asymptomatic cases. VATS is for recurrent or persistent cases.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.