eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pneumatocele: Follow-up

Author: Denise Serebrisky, MD, Assistant Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Director, Jacobi Asthma and Allergy Center for Children
Coauthor(s): Arthur B Atlas, MD, Assistant Clinical Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey; Debra Boyer, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Boston
Contributor Information and Disclosures

Updated: Apr 2, 2008

Follow-up

Further Inpatient Care

  • After starting appropriate intravenous antibiotic therapy, perform chest radiography to monitor improvement of pneumonia and progression of the pneumatocele.
  • If significant pleural effusion is present or develops, consider thoracentesis and/or chest tube drainage.

Further Outpatient Care

  • Most pneumatoceles resolve completely in a few weeks to months. However, in some healthy children, pneumatoceles persist as long as 16 months. Therefore, intermittent outpatient monitoring of chest radiographs is appropriate until resolution. Some recommend chest CT imaging after the findings on plain radiography are clear to ensure complete resolution. However, no clearly recognized radiological or clinical signs help to predict progression of the pneumatocele.
  • Findings on pulmonary function studies frequently are abnormal initially because of a restrictive defect and, at times, an obstructive defect. Over time, these abnormalities improve and, most often, return to normal predicted ranges. These should not be routinely performed during the acute stages. The increased pressures in spirometry may increase the risk of rupture.

Inpatient & Outpatient Medications

  • No further medications are required.

Transfer

  • Consider transfer to an intensive care unit when a large tension pneumatocele is causing cardiovascular compromise or significant airway obstruction.
  • Similarly, consider transfer to an intensive care unit if a rupture of the pneumatocele causes a pneumothorax.

Deterrence/Prevention

  • No preventative therapy is available.

Complications

  • Tension pneumatocele: A tension pneumatocele can develop if airtrapping continues and the pneumatocele expands. This complication occurs most frequently with positive pressure ventilation. If severe, the lesion can cause compression of adjacent structures, with hemodynamic instability and severe airway obstruction. If unrecognized and untreated, this can result in respiratory failure and death.
  • Pneumothorax: Pneumothorax can occur from a pneumatocele rupturing into the pleural space. This can lead to collapse of the lung, requiring evacuation of the pleural air to reexpand the lung. A bronchopleural fistula can result as a complication of the pneumothorax.
  • Infected pneumatoceles: A pneumatocele can become secondarily infected, usually by a different bacterium from the one that caused the primary pneumonia. Some advocate percutaneous drainage of infected pneumatoceles, especially if fluid- or pus-filled to prevent the development of severe lung abscess that may require surgical excision. Drainage can be both diagnostic and therapeutic. If drained, the fluid should be cultured for bacteria and fungus.

Prognosis

  • In general, an uncomplicated pneumatocele carries an excellent prognosis. As discussed, complete resolution of the pneumatocele is the most common outcome.
  • Rare complications, including tension pneumatocele, can lead to death from respiratory or cardiovascular collapse from progressive enlargement of the pneumatocele. However, this is rare and, if detected promptly, can be properly treated.

Patient Education

  • No specific educational requirements are indicated.

Miscellaneous

Medicolegal Pitfalls

Although most pneumatoceles resolve without sequelae, recognition of the following potential complications may prevent an unexpected poor outcome:

  • Cardiovascular or respiratory collapse secondary to a tension pneumatocele
  • Pneumothorax secondary to a ruptured pneumatocele

 


More on Pneumatocele

Overview: Pneumatocele
Differential Diagnoses & Workup: Pneumatocele
Treatment & Medication: Pneumatocele
Follow-up: Pneumatocele
Multimedia: Pneumatocele
References
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References

  1. Imamoglu M, Cay A, Kosucu P, et al. Pneumatoceles in postpneumonic empyema: an algorithmic approach. J Pediatr Surg. Jul 2005;40(7):1111-7. [Medline].

  2. Carrey J. On the natural regression of pulmonary cysts during early infancy. Pediatr. 1953;11:48-64.

  3. Conway DJ. The origin of lung cysts in childhood. Arch Dis Child. 1951;26:504-529.

  4. Boisset GF. Subpleural emphysema complicating staphylococcal and other pneumonias. J Pediatr. Aug 1972;81(2):259-66. [Medline].

  5. Galea MH, Williams N, Mayell MJ. Traumatic pneumatocele. J Pediatr Surg. Dec 1992;27(12):1523-4. [Medline].

  6. Amitai I, Mogle P, Godfrey S, Aviad I. Pneumatocele in infants and children. Report of 12 cases. Clin Pediatr (Phila). Jun 1983;22(6):420-2. [Medline].

  7. Kunyoshi V, Cataneo DC, Cataneo AJ. Complicated pneumonias with empyema and/or pneumatocele in children. Pediatr Surg Int. Feb 2006;22(2):186-90. [Medline].

  8. Shamberger RC, Wohl ME, Perez-Atayde A, Hendren WH. Pneumatocele complicating hyperimmunoglobulin E syndrome (Job's Syndrome). Ann Thorac Surg. Dec 1992;54(6):1206-8. [Medline].

  9. Zuhdi MK, Spear RM, Worthen HM, Peterson BM. Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children. Crit Care Med. Feb 1996;24(2):330-3. [Medline].

  10. Levison ME, Fung S. Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options. Curr Infect Dis Rep. Jan 2006;8(1):23-30. [Medline].

  11. Asmar BI, Thirumoorthi MC, Dajani AS. Pneumococcal pneumonia with pneumatocele formation. Am J Dis Child. Nov 1978;132(11):1091-3. [Medline].

  12. Chartrand SA, McCracken GH Jr. Staphylococcal pneumonia in infants and children. Pediatr Infect Dis. Jan-Feb 1982;1(1):19-23. [Medline].

  13. Chitayat D, Diamant S, Lazevnick R, Spirer Z. Haemophilus influenzae type B pneumonia with pneumatocele formation. Clin Pediatr (Phila). Feb 1980;19(2):151-2. [Medline].

  14. Hendren WH, Haggerty RJ. Staphylococcal pneumonia in infancy and childhood: Analysis of 75 cases. JAMA. 1958;168:6-16.

  15. Joosten KF, Hazelzet JA, Tiddens HA, et al. Staphylococcal pneumonia in childhood: will early surgical intervention lower mortality?. Pediatr Pulmonol. Aug 1995;20(2):83-8. [Medline].

  16. Khan EA, Wafelman LS, Garcia-Prats JA, Taber LH. Serratia marcescens pneumonia, empyema and pneumatocele in a preterm neonate. Pediatr Infect Dis J. Oct 1997;16(10):1003-5. [Medline].

  17. Knight GJ, Carman PG. Primary staphylococcal pneumonia in childhood: a review of 69 cases. J Paediatr Child Health. Dec 1992;28(6):447-50. [Medline].

  18. McGarry T, Giosa R, Rohman M, Huang CT. Pneumatocele formation in adult pneumonia. Chest. Oct 1987;92(4):717-20. [Medline].

  19. Quigley MJ, Fraser RS. Pulmonary pneumatocele: pathology and pathogenesis. AJR Am J Roentgenol. Jun 1988;150(6):1275-7. [Medline].

  20. Schimpl G, Schneider U. Traumatic pneumatoceles in an infant: case report and review of the literature. Eur J Pediatr Surg. Apr 1996;6(2):104-6. [Medline].

  21. Shen HN, Lu FL, Wu HD, et al. Management of tension pneumatocele with high-frequency oscillatory ventilation. Chest. Jan 2002;121(1):284-6. [Medline]. [Full Text].

  22. Victoria MS, Steiner P, Rao M. Persistent postpneumonic pneumatoceles in children. Chest. Mar 1981;79(3):359-61. [Medline].

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Further Reading

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Keywords

pneumatocele, infectious pneumatocele, traumatic pneumatocele, lung cysts, bullae, subpleural emphysema, postinfectious pulmonary cysts, Staphylococcus aureus, pneumonia, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, group A streptococci, Serratia marcescens, Klebsiella pneumoniae, adenovirus, tuberculosis, hydrocarbon ingestion, positive pressure ventilation, ball-valve obstruction, tension pneumatocele, pneumothorax, secondarily infected pneumatocele, hyperimmunoglobulin E syndrome, hyper-IgE syndrome, Buckley-Job syndrome

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Contributor Information and Disclosures

Author

Denise Serebrisky, MD, Assistant Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Director, Jacobi Asthma and Allergy Center for Children
Denise Serebrisky, MD is a member of the following medical societies: American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Arthur B Atlas, MD, Assistant Clinical Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey
Arthur B Atlas, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Lung Association, American Thoracic Society, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Debra Boyer, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Boston
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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