A 26-yr -old, previously healthy, naval diving officer is admitted to the hospital with a sudden onset,
left-sided chest pain. A CXR confirms a small left-sided pneumothorax. The pt is slightly
breathless and his oxygen saturation on air is 95%. He smokes 5–10 cigarettes a day. Which of
the following statements is true?
A. Simple aspiration is the first-line
B. Rx if the pt is symptomatic
C. If admitted for observation, he does not need oxygen
D. Once the pneumothorax has resolved he can go back to work, including resuming his diving duties
E. Smoking cessation has no role in management, apart from in the prevention of COPD in later life
Answer:
B. Rx if the pt is symptomatic
Discussion: He should be treated with a small (10– 14 F)-sized chest drain. A small pneumothorax in a person with no previous chest disease should be aspirated if the pt is breathless. A pneumothorax
can be classed as small or large depending on the presence of a visible rim of < 2 cm or ≥ 2 cm
between the lung margin and the chest wall. Ideally, an asymptomatic pt with a small, primary spontaneous pneumothorax can be discharged with the advice to return if he becomes symptomatic.
If a pt is admitted for observation, high-flow oxygen increases the absorption of air from the
pleural cavity. Smoking increases the chances of a recurrence. Diving is contraindicated unless
the pt has undergone pleurectomy.
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