A 24-year-old tall, thin man presents with sudden-onset right-sided pleuritic chest pain and mild breathlessness while playing football. He is a non-smoker. Examination reveals decreased breath sounds and hyperresonance on the right. Chest X-ray confirms a 3 cm right-sided primary spontaneous pneumothorax. He is hemodynamically stable. What is the most appropriate initial management?
- A Needle aspiration with a small-bore cannula ✓
- B Immediate intercostal tube drainage (chest tube)
- C High-flow oxygen and observation alone
- D Video-assisted thoracoscopic surgery (VATS) bullectomy
Correct answer: A. Needle aspiration with a small-bore cannula
Explanation
BTS 2010 guidelines recommend needle aspiration as first-line for symptomatic primary spontaneous pneumothorax ≥2 cm. This patient has a 3 cm pneumothorax with symptoms (pleuritic pain and breathlessness), so intervention is indicated. Observation is only for small (<2 cm) asymptomatic pneumothoraces. Chest tube is second-line if aspiration fails. VATS is reserved for recurrent pneumothorax or persistent air leak.
Reference: British Thoracic Society Pleural Disease Guideline 2010 (Thorax)
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.