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.
No preventative therapy is available.
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.
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.
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Pneumonia with multiple pneumatoceles.
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Pneumonia with pneumatocele (lateral).
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Resolving pneumatocele.
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Chest CT scan of pneumonia with pneumatocele.
