11th January 2024

Pneumothorax

Pneumothorax occurs more commonly in patients with respiratory diseases, and up to 20% of ILD patients develop this complication at some point.
All ILD patients with pneumothorax should be admitted for at least 24 hours.
Pneumothorax size should be measured using distance between hilum and ribcage. This will determine further steps:
1. If the patient is breathless at presentation, or their pneumothorax is >2cm, chest drain should be inserted
2. If the patient is not breathless, and their pneumothorax is 1-2cm, aspirate up to 2.5L of air with a cannula and assess response with a chest x-ray. If pneumothorax is still >1cm, chest drain should be inserted. If it reduces to <1cm, admit for 24hrs with high-flow oxygen
3. If the patient is not breathless, and their pneumothorax is <1cm, admit for 24hrs with high-flow oxygen
Such patients should always be discussed with a chest physician on admission, and if air leak persists at 48hrs after drain insertion – with thoracic surgeons for consideration of surgical management.

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