What is spontaneous pneumothorax?
What are the signs and symptoms of spontaneous pneumothorax?
How is spontaneous pneumothorax diagnosed?
Treatment of spontaneous pneumothorax
Will my child need surgery?
A spontaneous pneumothorax is the sudden onset of a collapsed lung without any apparent cause, such as a traumatic injury to the chest or a known lung disease. A collapsed lung is caused by the collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath. In most cases of spontaneous pneumothorax, a small area in the lung that is filled with air, called a bleb, ruptures, causing the air to leak into the space around the lung.
Spontaneous pneumothorax can be either small or large. A small spontaneous pneumothorax may resolve without treatment, while larger pneumothorax may need surgical intervention.
In most cases of spontaneous pneumothorax, the cause is unknown. Tall and thin adolescent males are typically at greatest risk, but females can also have this condition. Other risk factors include connective tissue disorders, smoking, and activities such as scuba diving, high altitudes and flying.
Spontaneous pneumothorax most commonly presents without severe symptoms.
Patients with a collapsed lung may experience a sudden onset of the following symptoms:
A larger pneumothorax will cause more severe symptoms, including:
If your child has a sudden onset of shortness of breath or sharp chest pain that is worsened by breathing, go to the Emergency Department to be evaluated or call 911. In order to make an accurate diagnosis, the medical team will evaluate your child’s symptoms and perform a physical exam, including the following:
Treatment of spontaneous pneumothorax depends on the duration, severity of symptoms and size of pneumothorax.
Patients who seek treatment for minimal or resolving symptoms after more than 24 hours will receive a chest X-ray to determine treatment. If the imaging reveals only a small pneumothorax, the patient may only require oxygen supplementation and observation in the hospital for a brief period of time.
Patients with large pneumothorax who seek treatment within a short time of the onset and present more severe symptoms may require placement of a chest tube (inserted between the ribs) to release the tension. In most cases, the placement of the chest tube allows the lung to re-expand fully and quickly.
The chest tube can be left in place for several days. During that time, your child must stay in the hospital for continued evaluation. She will undergo a series of chest X-rays to monitor the pneumothorax and determine if it is improving or worsening.
Some patients with a pneumothorax may also receive supplemental oxygen, which may improve symptoms and can help the air around the lung be reabsorbed more quickly.
Patients with a persistent air leak from the chest tube for more than five days or those with recurrent or bilateral spontaneous pneumothorax may be candidates for surgery.
Goals of surgery:
The operation is usually performed using a video-assisted thoracic surgery (VATS), with two to four small incisions.
After your child has surgery to treat spontaneous pneumothorax, she will spend an hour or so recovering in the post-acute care unit before returning to a room in the hospital. She will likely have a chest tube after the operation, which may need to remain in place for a number of days.
Your child will experience some pain and will receive pain medications throughout the stay. Some patients will initially require IV pain medications and then transition to oral pain medications. The pain management team will work with the surgical team and your child to provide adequate pain control.
Your child may have chest incisions with a clear adhesive glue dressing or gauze covering the site. The clear adhesive will dissolve and peel off naturally; the gauze dressings will be removed 48-72 hours after surgery.
If your child has an operation or receives inpatient treatment with a chest tube or oxygen therapy to treat spontaneous pneumothorax, you will need to make an appointment to see the surgeon for follow-up three to four weeks after discharge.
After your child has been treated for spontaneous pneumothorax, it is important that you carefully monitor her health. Call the doctor if your child experiences any of the following symptoms:
If your child suffers any of the following signs or symptoms, she must be brought to the Emergency Department as quickly as possible to receive proper treatment:
To make an appointment to have your child evaluated by CHOP’s Division of Pediatric, General, Thoracic and Fetal Surgery, please call 215-590-2730.
Created by: Kenya Gary MSN, CRNP
Reviewed by: Joy L. Collins, MD, FAAP, FACS