Mr. D, a 36 y/o male, a 5 pack year smoker w/no PMHx presents to the clinic with sudden onset right sided posterior rib pain x 1 day. Pts vitals reveal patient is hypotensive and tachycardic and exam is positive for tenderness to palpation on right intercostal muscles and diminished lung sounds in the right lung fields causing suspicion for spontaneous PTX. Imaging confirmed diagnosis showing right sided spontaneous PTX.

He was sent to the ER immediately by ambulance. While we sent him out we started to discuss whether the patient would need a needle aspiration or chest tube placement. I decided to look into this a little further to see if there was any benefit of getting one or the other. I was able to find a meta analysis of RCT’s in which they compare needle aspiration with chest tube drainages in patients suffering with PSP. The patient population investigated included caucasians and it included studies up to 2017 making it a fairly up to date study. For outcomes they looked at length of hospital stay, immediate success rate, one-year recurrence rate, hospitalization rate and complications rate.

• For immediate success rate they found  no significant difference were found between needle aspiration treatment and chest tube drainage (RR: 1.01; 95% CI: 0.70–1.46; P=0.96).
• For hospital stay they found that that needle aspiration significantly shortened the hospital stay (WMD: ‒1.67 days; 95% CI: ‒2.25 to 1.08; P<0.001)
• For One-year recurrence rate there were no significant difference regarding one year recurrence rate between the patients applied with needle aspiration and chest tube drainage (RR: 0.89; 95% CI: 0.58–1.38; P=0.61).
• For Lower Hospitalization rate they found needle aspiration group had lower hospitalization rate compared with chest tube drainage group (RR: 0.40; 95% CI: 0.22–0.75; P=0.004)

In conclusion the authors recommend needle aspiration for treating PSP to reduce hospitalization rate and shorten hospital stay. They go on to explain that both needle aspiration and chest tube placement have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.

For our patient who was sent to the ER they performed a needle aspiration followed by a chest tube placement.

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