Pediatric pneumothorax: Case studies and review of current literature

The Risk of Pneumothorax With Intrapleural Urokinase in Children With Parapneumonic Effusion

AIM

Fibrinolytic therapy is commonly used in children with parapneumonic effusion, to facilitate drainage of the effusions and recovery. However, data regarding complications of this treatment in children are limited. We aimed to determine the incidence of pneumothorax (PNX) associated with intrapleural urokinase.

METHODS

We analyzed retrospectively collected data of children with parapneumonic effusion who underwent chest drain insertion. The clinical course and complications, including the incidence of PNX, were compared between children who were and were not treated with urokinase.

RESULTS

The study group included 120 children, of whom 57 were treated with urokinase. Children who were and were not treated with urokinase did not differ in markers of disease severity or in the length of hospitalization. Among the patients treated with urokinase compared to those not treated, the incidence of PNX was higher (35% vs. 6%, p < 0.001) and the median duration of chest drain treatment was longer (6 vs. 4 days, p < 0.001).

CONCLUSION

In our pediatric cohort, intrapleural urokinase was associated with a higher incidence of PNX and did not shorten the duration of hospitalization.

Pneumothorax and pneumomediastinum in children

Pneumothorax is a condition that describes the presence of air between the visceral and parietal pleura sheets and the consequent collapse of the lungs. The collapse of the lungs can be partial or total and can present in different clinical stages, such as a high-pressure pneumothorax that can cause a mediastinal shift. Pneumomediastinum is the presence of free air between the mediastinal tissues due to various causes. It can manifest spontaneously and be minimally symptomatic but can also develop due to severe complications. Its etiology includes numerous iatrogenic and traumatic factors. Although spontaneous pneumothorax and pneumomediastinum that develop in childhood are similar to adult patients, it is important to determine the appropriate treatment strategy in addition to the age group, the effectiveness of the treatment, the role of the applied treatment in reducing recurrence, and the etiologyoriented treatments if there is an underlying pathology.

Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective

OBJECTIVE

Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication.

METHODS

Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges.

RESULTS

A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001).

CONCLUSION

Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Pneumothorax After a Fall in a Healthy Adolescent Athlete

A pneumothorax is a pathological collection of air in the pleural space within the thoracic cavity. Pneumothoraxes are classified by the underlying etiology as spontaneous or traumatic, with spontaneous pneumothoraxes being further categorized into primary and secondary causes. Management historically involved admission with possible administration of oxygen or chest tube placements based on severity. We herein describe a pediatric ­case of a likely blunt-force traumatic pneumothorax after a fall, successfully managed conservatively in the outpatient setting. The case highlights an acceleration-deceleration blunt trauma caused during a tackle at a football game and the importance of the clinical presentation, physical exam, and confirmation with a chest X-ray.