- Author: Denise Serebrisky, MD; Chief Editor: Michael R Bye, MD more...
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.
No specific educational requirements are indicated.
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