Case Report: Clinical Diagnosis of Pneumothorax–Loss of Syringe Plunger Recoil and Recommendation on Waiting For Spontaneous Closure of Broncho-Pleural Fistula

Abstract

Tension-type pneumothorax in particular is a life-threatening emergency that requires prompt diagnosis and treatment. Although imaging modalities—a chest CT scan being the gold standard—are frequently employed for confirmation, clinical diagnosis is essential in cases when imaging delays could be lethal. A bronchopleural fistula (BPF) complicated spontaneous pneumothorax in an obese patient with a body mass index of 43.6 kg/m². Before the chest tube was inserted, the diagnosis was verified by a straightforward and repeatable bedside diagnostic technique: loss of syringe plunger recoil following pleural entrance with a 16G trocar cannula. The patient experienced a persistent air leak that was consistent with BPF after tube thoracostomy, and this was meticulously watched. After three weeks of conservative treatment, the air leak eventually closed on its own, negating the need for surgery. This case demonstrates how the syringe plunger recoil test can be used as a simple and trustworthy bedside tool to support imaging in the quick diagnosis of pneumothorax, enabling prompt treatment to start. It also implies that a cautious conservative approach may allow for the spontaneous closure of a bronchopleural fistula with careful monitoring and the right safeguards, saving some patients from the hazards associated with major surgery.