C. Discharge with standard advice – Explanation

Questions sometimes discuss the size of the pneumothorax in percentage terms rather than giving
the interpleural distance. A variety of formulas have been proposed to convert between the two.
As a very general rule of thumb:

A pneumothorax of 20% if therefore within the 2 cm limit suggested by the British Thoracic Society
for observation, if the patient is not short of breath.
Pneumothorax
The British Thoracic Society (BTS) published updated guidelines for the management of
spontaneous pneumothorax in 2010. A pneumothorax is termed primary if there is no underlying
lung disease and secondary if there is
Primary pneumothorax
Recommendations include:

• if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
• otherwise aspiration should be attempted
• if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Secondary pneumothorax
Recommendations include:

• if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a
  chest drain should be inserted.
• otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e.
  pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be
  admitted for at least 24 hours
• if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting
  for 24 hours
• regarding scuba diving, the BTS guidelines state: ‘Diving should be permanently avoided unless
  the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT
  scan postoperatively.’

Iatrogenic pneumothorax
Recommendations include:

• less likelihood of recurrence than spontaneous pneumothorax
• majority will resolve with observation, if treatment is required then aspiration should be used

• ventilated patients need chest drains, as may some patients with COPD