Conservative management of a complete primary spontaneous pneumothorax

Large primary spontaneous pneumothorax (PSP) has traditionally been managed with needle aspiration, chest tube drainage and, in refractory cases, thoracic surgery. A recent randomized trial, however, provided evidence that a conservative observational approach was safe and 85% of patients recovered without requiring pleural drainage interventions. A conservative approach provided similar re-expansion rates at 8 weeks compared with chest tube drainage and offered the advantages of early hospital discharge, fewer days off work and avoidance of procedural risks. Nonetheless, clinicians are understandably anxious with conservative (non-drainage) management for patients with very large pneumothorax. Here, we report a patient with a right-sided PSP and total lung collapse that was managed successfully without intervention with minimal time in hospital or off work.