Pediatric Pneumothorax Workup
- Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Michael R Bye, MD more...
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.
Transillumination of the chest may help to establish the diagnosis in the newborn infant.
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.
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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