Breathless and/or Large Pneumothorax (visible rim >2 cm between the lung margin and the chest wall):
1. First Line:
. Percutaneous Aspiration: Initial management to remove air from the pleural space.
2. Consider:
. Chest Drain and Hospital Admission: If percutaneous aspiration fails or if the patient remains symptomatic.
. Supplemental Oxygen: To help resorb the pneumothorax faster.
. Surgery: For recurrent pneumothorax or persistent air leak.
Small Pneumothorax (visible rim ≤2 cm between the lung margin and the chest wall):
1. First Line:
. Observation: Monitor the patient with repeat imaging to ensure resolution.
. ± Supplemental Oxygen: To help speed up the resorption of the pneumothorax.
Key Points:
i. Primary Spontaneous Pneumothorax: Typically occurs without prior lung disease and often affects tall, thin, young males.
ii. Symptoms: Sudden onset dyspnoea and chest pain without a clear cause.
iii. Initial Diagnosis: Confirm with an erect chest X-ray if the patient is stable.
Additional Management Notes:
i. Erect Chest X-ray: To confirm the presence and size of the pneumothorax.
ii. Observation: For small, asymptomatic pneumothoraxes.
iii. Percutaneous Aspiration: For larger pneumothoraxes or symptomatic patients.
iv. Chest Drain: For patients not responding to aspiration or with recurrent pneumothorax.
v. Surgical Intervention: Considered for recurrent cases or persistent air leaks.
vi. Supplemental Oxygen: Helps in the resolution of the pneumothorax by increasing the rate of air resorption.