A pneumothorax is a collection of air in the pleural space commonly associated with respiratory symptoms. Patients may be relatively asymptomatic but may present with life-threatening distress. Confirmation of a clinically suspected pneumothorax is most often by chest x-ray when patients have been stabilized. Pneumothoraces are first categorized as primary, secondary, or iatrogenic and informs the evaluation and treatment plan. However, despite management guidelines in the literature, their applicability for pediatric patients is limited. Understanding of the historical risk factors including the acute clinical course and how radiographs, both chest X-ray and CT chest illuminate which patients are at highest risk for pneumothorax recurrence remains controversial. Over time most surgeons have adopted video-assisted thoracoscopic surgery (VATS) versus an open (limited axillary thoracotomy) approach mostly related to improved patient comfort, perceived improved risk-benefit ratio including similar recurrence rates of PTX. The method of surgical stapling, need for pleurodesis, and other aspects of the surgical approach remain controversial. Common practice for first episodes of primary spontaneous pneumothorax without persistent air leak includes the acute treatment and then observation with further evaluation and treatment typically reserved for a subsequent PTX. Special circumstances may be considered for a more aggressive surgical approach. Lack of consistency in current guidelines and lack of quality data in pediatric aged patients limits our ability to create clear treatment algorithms. Further research is needed and likely will require a multicenter approach.
EC Pulmonology and Respiratory Medicine
Pneumothorax; Pediatric Pulmonologist; Video-Assisted Thoracoscopic Surgery (VATS)
Terrence W Carver. “Pneumothorax: What’s a Pediatric Pulmonologist To Do?”. EC Pulmonology and Respiratory Medicine 8.12 (2019): 01-04.