A 21-year-old tall, thin male smoker presents with sudden right-sided pleuritic pain and mild breathlessness. Chest radiograph shows a primary spontaneous pneumothorax with a 1 cm rim of air measured at the level of the hilum. He remains comfortable with saturations of 96% on room air. What is the most appropriate management?
- A Observation with repeat radiograph and early outpatient review ✓
- B Needle aspiration of the pneumothorax
- C Insertion of an intercostal chest drain
- D Video-assisted thoracoscopic pleurodesis during this admission
Correct answer: A. Observation with repeat radiograph and early outpatient review
Explanation
In a primary spontaneous pneumothorax smaller than 2 cm at the hilum in a patient who is not significantly breathless, conservative management is recommended: the air resorbs at roughly 1.25% of hemithoracic volume per day, accelerated by supplemental oxygen, with follow-up imaging in 2 to 4 weeks. Drainage and aspiration are reserved for larger or symptomatic pneumothoraces, and surgical pleurodesis is second-line prophylaxis after recurrence or persistent air leak, making the other options excessive here.
Reference: Fishman's Pulmonary Diseases and Disorders, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.