Suprascapular Chest Tube Placement for Symptomatic Spontaneous Pneumothorax: The Forgotten Access Point

Spontaneous pneumothorax is a common complication of advanced interstitial and emphysematous lung disease. Chest tube drainage is the mainstay of pneumothorax management. Conventional insertion sites-lateral placement in the 4th-6th intercostal space (Bülau position) and anterior placement in the 2nd-3rd intercostal space (Monaldi position) are widely used but may be contraindicated in specific clinical scenarios. The suprascapular (posterior apical) approach represents a rarely utilised alternative. We report a 72-year-old male with COPD and emphysema who presented with a symptomatic apical pneumothorax. Computed tomography demonstrated minimal lateral pleural separation, making lateral access unsafe. The anterior route was also contraindicated due to a large postoperative wound following recent surgery. A suprascapular approach was therefore selected. Under local anaesthesia, an 8Fr pigtail catheter was inserted using anatomical landmarks and the pneumothorax was successfully evacuated with continuous negative pressure without complications. This case demonstrates that suprascapular chest tube placement can be a safe and effective alternative in selected patients with apical pneumothorax when standard insertion sites are contraindicated.