Paediatric Respiratory Reviews
Volume 10, Issue 3 , Pages 110-117 , September 2009

Evidence-based management of paediatric primary spontaneous pneumothorax

  • Paul D. Robinson

      Affiliations

    • Department of Respiratory Medicine, The Children's Hospital at Westmead, Australia
    • The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics and Child Health, University of Sydney, Australia
    • Corresponding Author InformationCorresponding author. The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145 Australia.
    • ,
  • Peter Cooper

      Affiliations

    • Department of Respiratory Medicine, The Children's Hospital at Westmead, Australia
    • ,
  • Sarath C. Ranganathan

      Affiliations

    • Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Australia
    • Infection, Immunity & Environment Theme, Murdoch Children's Research Institute, Australia
    • Department of Paediatrics, University of Melbourne, Australia

References 

  1. Melton LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979;120:1379–1382
  2. Bense L, Lewander R, Eklund G, Hedenstierna G, Wiman LG. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs. Chest. 1993;103:433–438
  3. Primrose WR. Spontaneous pneumothorax: a retrospective review of aetiology, pathogenesis and management. Scott Med J. 1984;29:15–20
  4. Metaxas EK, Condilis N, Tzatzadakis N, Dervisoglou A, Athanasiadi K, Gerazounis MI. Spontaneous pneumothorax. When and how to treat. Ann Ital Chir. 2007;78:17–20
  5. Katar S, Devecioglu C, Kervancioglu M, Ulku R. Symptomatic spontaneous pneumothorax in term newborns. Pediatr Surg Int. 2006;22:755–758
  6. Poenaru D, Yazbeck S, Murphy S. Primary spontaneous pneumothorax in children. J Pediatr Surg. 1994;29:1183–1185
  7. West JB. Distribution of mechanical stress in the lung, a possible factor in localisation of pulmonary disease. Lancet. 1971;1:839–841
  8. Toro JR, Pautler SE, Stewart L, et al. Lung cysts, spontaneous pneumothorax, and genetic associations in 89 families with Birt-Hogg-Dube syndrome. Am J Respir Crit Care Med. 2007;175:1044–1053
  9. Nickerson ML, Warren MB, Toro JR, et al. Mutations in a novel gene lead to kidney tumors, lung wall defects, and benign tumors of the hair follicle in patients with the Birt-Hogg-Dube syndrome. Cancer Cell. 2002;2:157–164
  10. Painter JN, Tapanainen H, Somer M, Tukiainen P, Aittomaki K. A 4-bp deletion in the Birt-Hogg-Dube gene (FLCN) causes dominantly inherited spontaneous pneumothorax. Am J Hum Genet. 2005;76:522–527
  11. Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax. With special reference to the ultrastructure of emphysematous bullae. Chest. 1980;77:771–776
  12. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342:868–874
  13. Cook CH, Melvin WS, Groner JI, Allen E, King DR. A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax. Surg Endosc. 1999;13:1208–1210
  14. Davis AM, Wensley DF, Phelan PD. Spontaneous pneumothorax in paediatric patients. Respir Med. 1993;87:531–534
  15. Seremetis MG. The management of spontaneous pneumothorax. Chest. 1970;57:65–68
  16. Thakar C, Hunt I, Anikin V. Horner's syndrome in a patient presenting with a spontaneous pneumothorax. Emerg Med J. 2008;25:119–120
  17. Mutalib M, Vandervelde C, Varghese A, et al. Horner's syndrome secondary to asymptomatic pneumothorax in an adolescent. Eur J Pediatr. 2007;166:507–508
  18. Seow A, Kazerooni EA, Pernicano PG, Neary M. Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces. AJR Am J Roentgenol. 1996;166:313–316
  19. Schramel FM, Wagenaar M, Sutedja TG, Golding RP, Postmus PE. Diagnosis of pneumothorax not improved by additional roentgen pictures of the thorax in the expiration phase. Ned Tijdschr Geneeskd. 1995;139:131–133
  20. Bradley M, Williams C, Walshaw MJ. The value of routine expiratory chest films in the diagnosis of pneumothorax. Arch Emerg Med. 1991;8:115–116
  21. Glazer HS, Anderson DJ, Wilson BS, Molina PL, Sagel SS. Pneumothorax: appearance on lateral chest radiographs. Radiology. 1989;173:707–711
  22. Qureshi FG, Sandulache VC, Richardson W, Ergun O, Ford HR, Hackam DJ. Primary vs delayed surgery for spontaneous pneumothorax in children: which is better?. J Pediatr Surg. 2005;40:166–169
  23. Engdahl O, Toft T, Boe J. Chest radiograph – a poor method for determining the size of a pneumothorax. Chest. 1993;103:26–29
  24. Paoloni R. Management and outcome of spontaneous pneumothoraces at three urban EDs. Emerg Med Australas. 2007;19:449–457
  25. Kelly AM. Review of management of primary spontaneous pneumothorax: is the best evidence clearer 15 years on?. Emerg Med Australas. 2007;19:303–308
  26. Hoi K, Turchin B, Kelly AM. How accurate is the Light index for estimating pneumothorax size?. Australas Radiol. 2007;51:196–198
  27. Kelly AM, Weldon D, Tsang AY, Graham CA. Comparison between two methods for estimating pneumothorax size from chest X-rays. Respir Med. 2006;100:1356–1359
  28. Noppen M. Pneumothorax size. Respir Med. 2006;100:1475;author reply 6
  29. De Leyn P, Lismonde M, Ninane V, et al. Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax. Acta Chir Belg. 2005;105:265–267
  30. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58(Suppl 2):ii39–ii52
  31. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602
  32. Kelly AM, Clooney M. Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia. Intern Med J. 2008;38:64–67
  33. Stradling P, Poole G. Conservative management of spontaneous pneumothorax. Thorax. 1966;21:145–149
  34. Northfield TC. Oxygen therapy for spontaneous pneumothorax. Br Med J. 1971;4:86–88
  35. Chan SS. The role of simple aspiration in the management of primary spontaneous pneumothorax. J Emerg Med. 2008;34:131–138
  36. Wakai A, O'Sullivan RG, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 2007(1): CD004479.
  37. O’Lone E, Elphick HE, Robinson PJ. Spontaneous pneumothorax in children: when is invasive treatment indicated?. Pediatr Pulmonol. 2008;43:41–46
  38. Wilcox DT, Glick PL, Karamanoukian HL, Allen JE, Azizkhan RG. Spontaneous pneumothorax: a single-institution, 12-year experience in patients under 16 years of age. J Pediatr Surg. 1995;30:1452–1454
  39. Vedam H, Barnes DJ. Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax. Intern Med J. 2003;33:495–499
  40. Marquette CH, Marx A, Leroy S, et al. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study. Eur Respir J. 2006;27:470–476
  41. Kaur S, Cortiella J, Vacanti CA. Diffusion of nitrous oxide into the pleural cavity. Br J Anaesth. 2001;87:894–896
  42. Matsuura Y, Nomimura T, Murakami H, Matsushima T, Kakehashi M, Kajihara H. Clinical analysis of reexpansion pulmonary edema. Chest. 1991;100:1562–1566
  43. Reed MF, Lyons JM, Luchette FA, Neu JA, Howington JA. Preliminary report of a prospective, randomized trial of underwater seal for spontaneous and iatrogenic pneumothorax. J Am Coll Surg. 2007;204:84–90
  44. Warner BW, Bailey WW, Shipley RT. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax. Am J Surg. 1991;162:39–42
  45. Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Respiration. 1992;59:221–227
  46. Smit HJ, Wienk MA, Schreurs AJ, Schramel FM, Postmus PE. Do bullae indicate a predisposition to recurrent pneumothorax?. Br J Radiol. 2000;73:356–359
  47. Guimaraes CV, Donnelly LF, Warner BW. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007;37:879–884
  48. Choudhary AK, Sellars ME, Wallis C, Cohen G, McHugh K. Primary spontaneous pneumothorax in children: the role of CT in guiding management. Clin Radiol. 2005;60:508–511
  49. Ouanes-Besbes L, Golli M, Knani J, et al. Prediction of recurrent spontaneous pneumothorax: CT scan findings versus management features. Respir Med. 2007;101:230–236
  50. Lesur O, Delorme N, Fromaget JM, Bernadac P, Polu JM. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest. 1990;98:341–347
  51. Donahue DM, Wright CD, Viale G, Mathisen DJ. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax. Chest. 1993;104:1767–1769
  52. Khan OA, Tsang GM, Barlow CW, Amer KM. Routine histological analysis of resected lung tissue in primary spontaneous pneumothorax – is it justified?. Heart Lung Circ. 2006;15:137–138
  53. Deslauriers J, Beaulieu M, Despres JP, Lemieux M, Leblanc J, Desmeules M. Transaxillary pleurectomy for treatment of spontaneous pneumothorax. Ann Thorac Surg. 1980;30:569–574
  54. Jimenez-Merchan R, Garcia-Diaz F, Arenas-Linares C, Giron-Arjona JC, Congregado-Loscertales M, Loscertales J. Comparative retrospective study of surgical treatment of spontaneous pneumothorax. Thoracotomy vs thoracoscopy. Surg Endosc. 1997;11:919–922
  55. Vohra HA, Adamson L, Weeden DF. Does video-assisted thoracoscopic pleurectomy result in better outcomes than open pleurectomy for primary spontaneous pneumothorax?. Interact Cardiovasc Thorac Surg. 2008;7:637–677
  56. Barker A, Maratos EC, Edmonds L, Lim E. Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomised and non-randomised trials. Lancet. 2007;370:329–335
  57. Treasure T. Minimal access surgery for pneumothorax. Lancet. 2007;370:294–295
  58. Ozcan C, McGahren ED, Rodgers BM. Thoracoscopic treatment of spontaneous pneumothorax in children. J Pediatr Surg. 2003;38:1459–1464
  59. Butterworth SA, Blair GK, LeBlanc JG, Skarsgard ED. An open and shut case for early VATS treatment of primary spontaneous pneumothorax in children. Can J Surg. 2007;50:171–174
  60. Zganjer M, Kljenak A. Video-assisted thoracoscopic surgery for spontaneous pneumothorax in children – our experience. Bratisl Lek Listy. 2007;108:200–202
  61. Light RW, O’Hara VS, Moritz TE, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study. JAMA. 1990;264:2224–2230
  62. Almind M, Lange P, Viskum K. Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis. Thorax. 1989;44:627–630
  63. Mouroux J, Elkaim D, Padovani B, et al. Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique and results of one hundred cases. J Thorac Cardiovasc Surg. 1996;112:385–391
  64. Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet. 1997;349:251–252
  65. Noppen M. Who's (still) afraid of talc?. Eur Respir J. 2007;29:619–621
  66. Aujla SJ, Michelson P, Langman CB, Shapiro R, Ellis D, Moritz ML. Refractory hypercalcemia in an infant secondary to talc pleurodesis resolving after renal transplantation. Am J Transplant. 2008;8:1329–1333
  67. Chee CB, Abisheganaden J, Yeo JK, et al. Persistent air-leak in spontaneous pneumothorax – clinical course and outcome. Respir Med. 1998;92:757–761
  68. Schramel FM, Postmus PE, Vanderschueren RG. Current aspects of spontaneous pneumothorax. Eur Respir J. 1997;10:1372–1379
  69. McLaughlin FJ, Matthews WJ, Strieder DJ, Khaw KT, Schuster S, Shwachman H. Pneumothorax in cystic fibrosis: management and outcome. J Pediatr. 1982;100:863–869
  70. Spector ML, Stern RC. Pneumothorax in cystic fibrosis: a 26-year experience. Ann Thorac Surg. 1989;47:204–207
  71. Taussig LM. Pediatric Respiratory Medicine. 2nd edn.. St Louis: Mosby-Year Book Inc; 2008;
  72. Shaw KS, Prasil P, Nguyen LT, Laberge JM. Pediatric spontaneous pneumothorax. Semin Pediatr Surg. 2003;12:55–61
  73. Light R. Pleural Diseases. 3rd edn.. Philadelphia: Lea & Febinger; 1990;
  74. Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraete A. Quantification of the size of primary spontaneous pneumothorax: accuracy of the Light index. Respiration. 2001;68:396–399
  75. Rhea JT, DeLuca SA, Greene RE. Determining the size of pneumothorax in the upright patient. Radiology. 1982;144:733–736
  76. Collins CD, Lopez A, Mathie A, Wood V, Jackson JE, Roddie ME. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR Am J Roentgenol. 1995;165:1127–1130
  77. Archer GJ, Hamilton AA, Upadhyay R, Finlay M, Grace PM. Results of simple aspiration of pneumothoraces. Br J Dis Chest. 1985;79:177–182
  78. Hayes JA, Burdon JG. The management of spontaneous pneumothorax by simple aspiration. Aust Fam Physician. 1988;17:458–462
  79. Markos J, McGonigle P, Phillips MJ. Pneumothorax: treatment by small-lumen catheter aspiration. Aust N Z J Med. 1990;20:775–781
  80. Delius RE, Obeid FN, Horst HM, Sorensen VJ, Fath JJ, Bivins BA. Catheter aspiration for simple pneumothorax. Experience with 114 patients. Arch Surg. 1989;124:833–836
  81. Harvey J, Prescott RJ. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee. BMJ. 1994;309:1338–1339
  82. Ng AW, Chan KW, Lee SK. Simple aspiration of pneumothorax. Singapore Med J. 1994;35:50–52
  83. Andrivet P, Djedaini K, Teboul JL, Brochard L, Dreyfuss D. Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration. Chest. 1995;108:335–339
  84. Soulsby T. British Thoracic Society guidelines for the management of spontaneous pneumothorax: do we comply with them and do they work?. J Accid Emerg Med. 1998;15:317–321
  85. Mendis D, El-Shanawany T, Mathur A, Redington AE. Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed?. Postgrad Med J. 2002;78:80–84
  86. Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med. 2002;165:1240–1244
  87. Packham S, Jaiswal P. Spontaneous pneumothorax: use of aspiration and outcomes of management by respiratory and general physicians. Postgrad Med J. 2003;79:345–347
  88. Faruqi S, Gupta D, Aggarwal AN, Jindal SK. Role of simple needle aspiration in the management of pneumothorax. Indian J Chest Dis Allied Sci. 2004;46:183–190
  89. Chan SS, Lam PK. Simple aspiration as initial treatment for primary spontaneous pneumothorax: results of 91 consecutive cases. J Emerg Med. 2005;28:133–138
  90. Kelly AM, Kerr D, Clooney M. Outcomes of emergency department patients treated for primary spontaneous pneumothorax. Chest. 2008;134:1033–1036

PII: S1526-0542(08)00082-1

doi: 10.1016/j.prrv.2008.12.003

Paediatric Respiratory Reviews
Volume 10, Issue 3 , Pages 110-117 , September 2009

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