Saturday July 8, 2006

Q: 21 year old male presented to ER with chest pain. CXR showed small spontaneous pneumothorax with less than 3 cm from apex to cupola. Saturation is 99% on room-air. Management is ?


A) Observation

B) Observation with oxygen

C) Aspiration of the pneumothorax

D) Aspiration of the pneumothorax with application of Heimlich valve or a water seal device

E) Chest tube to suction


Ans. is B (or A)

Clinically stable patient with small primary pneumothorax with less than 3 cm from apex to cupola, should be observed. There is some evidence available that administration of oxygen may speed up resolution of the pneumothorax (exercise caution in patients with COPD).


Read 2 guidelines for management of spontaneous pneumothorax:

1) An American College of Chest Physicians Delphi Consensus Statement Chest. 2001;119:590-602
2) BTS guidelines for the management of spontaneous pneumothorax Thorax 2003;58:ii39