Georgia Koltsida, MD, Casandra Arevalo-Marcano, MD, and Lee J. Brooks, MD, FAAP
•Pneumothorax, an unusual but life-threatening condition in children, is defined as the accumulation of air in the pleural space that can enter via disruption of any surface of the pleura.
•Pneumothorax can be classified as spontaneous or traumatic.
•Spontaneous pneumothorax usually occurs without a clear precipitating factor, such as iatrogenic or traumatic causes. It can be further categorized as primary (idiopathic) pneumothorax or secondary pneumothorax, based on the etiologic origin.
•The overall incidence is 5 to 10 per 100,000 children <18 years of age.
•Pneumothorax is most common in newborns and teenaged boys. Spontaneous pneumothorax has a strong male predominance (it is 6 times more prevalent in boys than in girls).
•It can present in reproductive-age girls as catamenial pneumothorax.
Risk Factors and Presentation
•The most common risk factors are smoking (creating a six- to ninefold increase in incidence), male sex, family history of spontaneous pneumothorax, tall stature, premature delivery, and asthma. However, any disease that promotes air leakage will increase the risk.
•Pneumothorax can be associated with a Valsalva maneuver but usually occurs in a resting individual.
•Symptomatology will depend on the amount of air leakage.
•The most common symptoms are acute chest pain (stabbing pain that radiates to the ipsilateral shoulder) and dyspnea. Sometimes a popping sensation is reported by patients.
•In small pneumothorax, the resolution of pain is observed in 24 hours.
•Spontaneous pneumothorax can be an incidental finding noted as part of routine chest radiography.
•Causes of secondary pneumothorax should be investigated. Special attention should be given to a history of smoking or the use of inhaled drugs, as well as a history of asthma.
•Body habitus should be noted, since pneumothorax occurs more frequently in tall boys.
•Note a history of Valsalva maneuver surrounding the event.
•Physical examination findings will be more pronounced with a larger pneumothorax. Findings can range from a mild decrease in aeration to complete absence of breath sounds in the affected lung.
•Subcutaneous emphysema is a common finding. Although it may be alarming for the patient and family, it does not create an increased risk of local infections, and management is focused on symptoms.
•Tension pneumothorax manifests with alarming signs and symptoms. There is a complete absence of breath sounds, with deviation of the trachea on chest radiographs to the contralateral hemithorax. Cardiac tamponade may result in vascular instability. Tension pneumothorax is an emergency and should be treated with prompt decompression (Figure 72-1).
•Secondary pneumothorax occurs as a complication of chronic or acute lung disease. It is a potentially life-threatening event because patients already have decreased cardiopulmonary reserve in the setting of their underlying disease. It also has a greater risk of recurrence.
•Secondary pneumothorax could occur because of
—Airway abnormalities: asthma, cystic fibrosis
—Parenchymal diseases: interstitial lung disease, emphysema