A tall, thin 21-year-old male smoker develops sudden right-sided pleuritic pain and mild breathlessness. Chest radiograph shows a right pneumothorax measuring 3 cm at the level of the hilum. He remains mildly dyspneic at rest. According to BTS guidance, what is the most appropriate initial intervention?
- A Observation with repeat radiograph in 4 hours
- B High-flow oxygen alone
- C Simple needle aspiration ✓
- D Immediate thoracotomy
Correct answer: C. Simple needle aspiration
Explanation
In a primary spontaneous pneumothorax, an interpleural distance exceeding 2 cm at the hilum or the presence of breathlessness mandates intervention, and simple needle aspiration is the recommended first procedure, with insertion of an intercostal drain reserved for failed aspiration. Observation alone is appropriate only for small (<2 cm) pneumothoraces in patients who are not breathless. Oxygen merely accelerates resorption and thoracotomy is reserved for recurrent cases requiring pleurodesis.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.