Medscape is available in 5 Language Editions – Choose your Edition here.


Pneumatocele Follow-up

  • Author: Denise Serebrisky, MD; Chief Editor: Michael R Bye, MD  more...
Updated: Jan 31, 2016

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.


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.


Inpatient & Outpatient Medications

No further medications are required.



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.



No preventative therapy is available.



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 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.

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.



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.

Contributor Information and Disclosures

Denise Serebrisky, MD Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center/North Central Bronx Hospital; Director, Jacobi Asthma and Allergy Center for Children, Jacobi Medical Center

Denise Serebrisky, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.


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, Medical Society of New Jersey

Disclosure: Received grant/research funds from astra zeneca for none.

Debra Boyer, MD Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Boston

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

  1. Hussain N, Noce T, Sharma P, Jagjivan B, Hegde P, Pappagallo M, et al. Pneumatoceles in preterm infants-incidence and outcome in the post-surfactant era. J Perinatol. 2010 May. 30(5):330-6. [Medline].

  2. Arora P, Kalra VK, Natarajan G. Pneumatoceles in infants in the neonatal intensive care unit: clinical characteristics and outcomes. Am J Perinatol. 2013 Sep. 30(8):689-94. [Medline].

  3. Van Hoorebeke E, Jorens PG, Wojciechowski M, Salgado R, Desager K, Van Schil P, et al. An unusual case of traumatic pneumatocele in a nine-year-old girl: a bronchial tear with clear bronchial laceration. Pediatr Pulmonol. 2009 Aug. 44(8):826-8. [Medline].

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

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

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

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

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

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

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

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

  12. Schimke LF, Sawalle-Belohradsky J, Roesler J, Wollenberg A, Rack A, Borte M, et al. Diagnostic approach to the hyper-IgE syndromes: immunologic and clinical key findings to differentiate hyper-IgE syndromes from atopic dermatitis. J Allergy Clin Immunol. 2010 Sep. 126(3):611-7.e1. [Medline].

  13. Hussain N, Noce T, Sharma P, Jagjivan B, Hegde P, Pappagallo M, et al. Pneumatoceles in preterm infants-incidence and outcome in the post-surfactant era. J Perinatol. 2009 Oct 8. [Medline].

  14. 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. 1996 Feb. 24(2):330-3. [Medline].

  15. Park TH, Kim JK. Nonsurgical management of an enlarging pneumatocele by fibrin sealant injection via pigtail catheter. Pediatr Pulmonol. 2016 Feb. 51 (2):E5-7. [Medline].

  16. Fujii AM, Moulton S. VATS management of an enlarging multicystic pneumatocele. J Perinatol. 2008 Jun. 28(6):445-7. [Medline].

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

  18. Al-Saleh S, Grasemann H, Cox P. Necrotizing pneumonia complicated by early and late pneumatoceles. Can Respir J. 2008 Apr. 15(3):129-32. [Medline]. [Full Text].

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

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

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

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

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

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

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

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

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

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

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

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

  31. Al-Ghafri M, Al-Hanshi S, Al-Ismaily S. Two Cases of Pneumatoceles in Mechanically Ventilated Infants. Oman Med J. 2015 Jul. 30 (4):299-302. [Medline].

Pneumonia with multiple pneumatoceles.
Pneumonia with pneumatocele (lateral).
Resolving pneumatocele.
Chest CT scan of pneumonia with pneumatocele.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.