Reconsidering conservative treatment of primary spontaneous pneumothoraces: A case report

Abstract

Background

Interventional management for primary spontaneous pneumothoraces (PSPs) appears to have become the norm, with conservative management having been pushed into the background over the past few decades. In the UK, management of PSPs is guided by the British Thoracic Society (BTS) Guidelines. While original guidance, dating back to 2011, favoured interventional management, the newly released updated BTS algorithm has given the conservative approach greater visibility.

Case report

A teenager presented to the Emergency Department after having developed sudden onset chest discomfort. A chest x-ray confirmed a PSP. He was admitted and initially treated conservatively. After 24 hours of observation, a chest drain was inserted on the basis of a lack of radiologic improvement. On discharge after chest drain removal, he was found to have a recurrence of his pneumothorax when reviewed at the outpatient respiratory clinic. He was again managed conservatively, this time successfully.

Why should the emergency physician be aware of this?

This case raised several questions regarding the management of stable patients presenting with PSP. The body of evidence supporting conservative management as a safe and feasible option has been growing. It is therefore important for physicians to reconsider its role and value. While the newly released BTS guidelines are a step in the right direction, there are a number of important questions to address in order to both effectively guide emergency physicians and for conservative management to be used in a more standardised and routine way.