Clearing the Air — A Conservative Option for Spontaneous Pneumothorax

For the patient who presents with a large primary pneumothorax (i.e., a pneumothorax with no clear underlying lung disease), there is little evidence to guide management. 1 There is general agreement that the air in the pleural space should be removed. If any disagreement exists, it has been about how best to remove it. The British Thoracic Society guidelines advise using a needle to aspirate the pneumothorax and if not successful to place a chest tube 2 ; the American College of Chest Physicians guidelines dispense with the needle and recommend chest-tube placement. 3 And yet, whether the intervention, along with the added pain . . .