What is the recommended initial management for a small, stable pneumothorax?

• A. Immediate chest tube
• B. Watch & Wait (<10%)
• C. Pleurodesis
• D. Oxygen only

Answer: (B)

Small, stable pneumothorax is best handled conservatively because there isn’t enough air to cause distress and the lung can re-expand on its own. Observing the patient with serial clinical checks and follow-up imaging allows the air to be reabsorbed without exposing them to the risks of invasive procedures. Analgesia and safe activity guidance are provided, and discharge can be considered if the patient remains asymptomatic and vitals stay stable, with clear instructions to return if symptoms worsen.

If the patient develops worsening symptoms or the pneumothorax enlarges on repeat imaging, escalation is appropriate, such as needle aspiration or chest tube drainage, depending on size and stability. Pleurodesis is reserved for recurrent or persistent air leaks, not the initial management. Supplemental oxygen can be used as an adjunct in some cases to help reabsorption, but it is not the primary approach when the pneumothorax is small and the patient is stable.