Pneumothorax in Children

Abstract

Pneumothorax is a common pleural disease worldwide and is defined as the free accumulation of air between visceral and parietal pleura. Pneumothorax can be spontaneous, iatrogenic, and traumatic. Although it is less common than adults, it is seen in about 1.1–4 per 100,000 per year in the childhood age group. In patients presenting with variable clinic according to the cause of etiology, diagnosis is confirmed on a PA chest radiograph, sometimes a computed tomography may be required. The management of pneumothorax is varying from conservative, over intermediate (chest tube drainage) to invasive methods (video-assisted thoracoscopic surgery—VATS, thoracotomy). Here, we planned to write a chapter that includes a text containing general information about pediatric pneumothorax, algorithms, and visual and clinical cases of the causes of pneumothorax in children, including age, etiology, and treatment approach of pneumothorax in children.

The Rare Presentation of Spontaneous Pneumothorax in a Pediatric Patient

“…Categories of pneumothorax include spontaneous, iatrogenic, and traumatic. Spontaneous pneumothorax is further broken down into primary (occurring secondary to blebs/bullae without other lung pathology) and secondary (occurring in relation to underlying acute and/or chronic lung diseases) [ 1 - 3 ]. A spontaneous pneumothorax is a relatively rare condition in children with the nadir of cases occurring in the neonatal or late adolescent period [ 2 , 3 ].…”

“…Spontaneous pneumothorax is further broken down into primary (occurring secondary to blebs/bullae without other lung pathology) and secondary (occurring in relation to underlying acute and/or chronic lung diseases) [ 1 - 3 ]. A spontaneous pneumothorax is a relatively rare condition in children with the nadir of cases occurring in the neonatal or late adolescent period [ 2 , 3 ]. Commonly known predisposing conditions for secondary spontaneous pneumothorax include ranging from asthma and foreign body aspiration to cystic fibrosis and chronic infectious etiologies.…”

“…Commonly known predisposing conditions for secondary spontaneous pneumothorax include ranging from asthma and foreign body aspiration to cystic fibrosis and chronic infectious etiologies. In such conditions, it is thought that chronic airway inflammation in smaller airways leads to obstructions that create increased pressures leading to air escape into the pleural space, and are then more susceptible to pneumothorax development [ 3 ].…”

“…The incidence of primary spontaneous pneumothorax in pediatric patient populations is estimated at 3.4/100,000 as opposed to the general adult population with 6-18/100,000 each year with a predominance towards males after eight years of age [ 3 , 4 ]. Preadolescent primary and secondary spontaneous pneumothorax incidence are approximately equivalent.…”

“…In smaller pneumothoraces, supplemental oxygen is often appropriate. However, larger cases may require a chest tube and more invasive surgical intervention including video-assisted thoracoscopic surgery (VATS) along with treatment of the underlying cause [ 3 ]. Fortunately, our patient required non-invasive management, and clinical improvement was achieved without surgical intervention.…”