Secondary Spontaneous Pneumothorax (SSP)

 

Breathless or Large Pneumothorax (visible rim >2 cm between the lung margin and the chest wall):

. First Line:

. Chest Drain and Hospital Admission: To manage the pneumothorax and monitor the patient.

. Consider:

. Supplemental Oxygen: To aid in the resolution of the pneumothorax.

. Surgery or Pleurodesis: For recurrent cases or persistent air leaks.

 

Moderate Pneumothorax (visible rim 1-2 cm between the lung margin and the chest wall):

. First Line:

. Percutaneous Aspiration ± High-Flow Oxygen: To remove air and improve oxygenation.

. Consider:

. Chest Drain and Hospital Admission ± Supplemental Oxygen: If aspiration fails or the patient remains symptomatic.

 

Small Pneumothorax (visible rim <1 cm between the lung margin and the chest wall):

. First Line:

. High-Flow Oxygen + Observation + Hospital Admission: To monitor the patient and facilitate reabsorption of the pneumothorax.

 

Key Points:

. Secondary Spontaneous Pneumothorax: Occurs in the presence of underlying lung disease, such as COPD or asthma.

. Symptoms: Sudden onset dyspnoea and chest pain, especially in individuals with a history of lung disease.

. Initial Diagnosis: Confirm with a chest X-ray if the patient is stable.

 

Additional Management Notes:

. Erect Chest X-ray: To confirm the presence and size of the pneumothorax.

. Percutaneous Aspiration: For moderate pneumothoraxes to remove air and prevent progression.

. Chest Drain: For larger pneumothoraxes or if initial aspiration is unsuccessful.

. Supplemental Oxygen: To aid in the resolution of the pneumothorax.

. Surgical Intervention: Considered for recurrent or persistent cases.

 

Summary of Management

 

Condition	First Line	Consider
Breathless or Large Pneumothorax (visible rim >2 cm between the lung margin and the chest wall)	Chest Drain and Hospital Admission To manage the pneumothorax and monitor the patient.	– Supplemental Oxygen To aid in the resolution of the pneumothorax. Surgery or Pleurodesis For recurrent cases or persistent air leaks
Moderate Pneumothorax (visible rim 1-2 cm between the lung margin and the chest wall)	Percutaneous Aspiration ± High-Flow Oxygen To remove air and improve oxygenation.	– Chest Drain and Hospital Admission ± Supplemental Oxygen If aspiration fails or the patient remains symptomatic.
Small Pneumothorax (visible rim <1 cm between the lung margin and the chest wall)	High-Flow Oxygen + Observation + Hospital Admission To monitor the patient and facilitate reabsorption of the pneumothorax.