Primary Spontaneous Pneumothorax:

 

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.