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Pediatric Pneumothorax Workup

  • Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Michael R Bye, MD  more...
 
Updated: Oct 26, 2015
 

Approach Considerations

Patients who present with respiratory distress should have an arterial blood gas (ABG) assessment. Hypoxemia occurs because of significant ventilation perfusion mismatch; however, hypercapnia is unusual in patients without underlying lung disease.

A tension pneumothorax should always be a clinical diagnosis, because death can occur before radiographs are obtained or developed.

A noncontrast chest computed tomography (CT) scan may be helpful to look for preexisting pulmonary pathologies such as blebs or bullae.

Ultrasonography has also been shown to be useful in detecting pneumothorax.[6]

Transillumination of the chest may help to establish the diagnosis in the newborn infant.

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Chest Radiography

Pneumothorax is generally a clinical diagnosis that is confirmed with upright chest radiography (see the following images). Anteroposterior (AP) and lateral views can reveal the presence of even small amounts of intrapleural air. Air in the pleural space that outlines the visceral pleura is a characteristic finding. Hyperlucency of vascular and lung markings on the affected side can be seen because of this air. Atelectasis may also be seen on the affected side, and the mediastinum and trachea may shift away from the pneumothorax.

A tension pneumothorax should always be a clinical diagnosis, because death can occur before the radiograph is obtained or developed.

Neonate with a right tension pneumothorax. Note thNeonate with a right tension pneumothorax. Note the tracheal deviation to the left.
Subcutaneous Emphysema and Pneumothorax Subcutaneous Emphysema and Pneumothorax

A small pneumothorax in a supine patient can be more easily detected in the lateral decubitus view.

When an infant is suspected of having a pneumothorax, AP radiographs are obtained in the supine position. Small pneumothoraces can be better visualized with a lateral decubitus film with the affected side up.

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Contributor Information and Disclosures
Author

William Gluckman, DO, MBA, FACEP President and CEO, FastER Urgent Care

William Gluckman, DO, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Coauthor(s)

Rene J Forti, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Rene J Forti, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics

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.

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

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

References
  1. Flume PA. Pulmonary complications of cystic fibrosis. Respir Care. 2009 May. 54(5):618-27. [Medline].

  2. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000 Mar 23. 342(12):868-74. [Medline].

  3. Al Tawil K, Abu-Ekteish FM, Tamimi O, Al Hathal MM, Al Hathlol K, Abu Laimun B. Symptomatic spontaneous pneumothorax in term newborn infants. Pediatr Pulmonol. 2004 May. 37(5):443-6. [Medline].

  4. Peng W, Zhu H, Shi H, Liu E. Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2014 Mar. 99 (2):F158-65. [Medline].

  5. [Guideline] Finnish Medical Society Duodecim. Differential diagnosis of chest pain. EBM Guidelines. 2008 May 16. [Full Text].

  6. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005 Sep. 12(9):844-9. [Medline].

  7. Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?. Am J Surg. 2014 Oct. 208 (4):571-6. [Medline].

  8. Chang SJ, Ross SW, Kiefer DJ, Anderson WE, Rogers AT, Sing RF, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014 Apr. 76 (4):1029-34. [Medline].

  9. Miller AC, Harvey JE. Guidelines for the management of spontaneous pneumothorax. Standards of Care Committee, British Thoracic Society. BMJ. 1993 Jul 10. 307(6896):114-6. [Medline].

  10. Halliday HL, Ehrenkranz RA, Doyle LW. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009 Jan 21. CD001146. [Medline].

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Neonate with a right tension pneumothorax. Note the tracheal deviation to the left.
Subcutaneous Emphysema and Pneumothorax
 
 
 
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