Pediatric Pneumothorax Clinical Presentation

Updated: Oct 16, 2019
  • Author: Andres Carrion, MD, FAAP; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Presentation

History

The severity of symptoms depends on the amount of air leakage, extent of lung collapse, rate of development, etiology, and underlying clinical status of the patient.

The most common symptoms are chest pain and dyspnea. Sometimes, patients report a popping sensation at the onset of symptoms. Spontaneous pneumothorax often occurs when a patient is at rest or with minimal exertion. Patients who are symptomatic may report a sudden onset of pleuritic chest pain that is sharp or stabbing. Patients with small pneumothoraces may occasionally have a dry or nonproductive cough.

A patient with a simple pneumothorax may also present with no symptoms, and it is found as an incidental finding on a chest radiograph. Symptoms of a small pneumothorax can resolve in 24 hours. Patients with a spontaneous pneumothorax secondary to preexisting lung disease may have a more dramatic presentation.

Premature neonates on mechanical ventilation may develop a pneumothorax as a result of positive pressure and respiratory system compliance, presenting with a quick deterioration and shock.

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Physical Examination

Careful assessment of vital signs should be done, as hypotension and hypoxemia can be present.

Findings are more pronounced with a large pneumothorax. An extensive pneumothorax often produces pleuritic chest pain, dyspnea, tachypnea, and cyanosis. Chest auscultation can range from mild decrease in aeration to complete absence of breath sounds on the affected side. In addition, hyperresonance to percussion may be noted on the affected side. Subcutaneous emphysema with crepitance is occasionally present.

Patients with a tension pneumothorax typically present in shock with severe respiratory distress and may have tracheal deviation to the unaffected side as a late sign.

If the pneumothorax is due to trauma, there could be areas of contusions or abrasions on the chest wall or a small puncture wound that does not allow free movement of air between the outside and the pleural cavity. Flail chest with paradoxical chest motion can also be seen.

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Complications

Complications may include the following:

  • Cardiac tamponade
  • Cardiopulmonary arrest
  • Hemothorax
  • Pneumopericardium
  • Pneumomediastinum
  • Shock
  • Tension pneumothorax

See the images below.

Pneumomediastinum. Pneumomediastinum.
Tension pneumothorax. Tension pneumothorax.

Also see Treatment/Complications

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