Spontaneous air leak in a Pediatric Emergency Department: An 11-year experience
Keywords:air leak, Pediatrics, spontaneous pneumomediastinum, pneumothorax
Introduction: Due to lack of data, the management of air leaks in children and adolescents is based on protocols for adults. In this study, the authors review and report their institutional experience in the area.
Methods: Retrospective and descriptive study of spontaneous air leak cases diagnosed in a Portuguese Pediatric Emergency Department (PED) between January 2007 and December 2018.
Results: Twenty-one episodes of spontaneous air leak were diagnosed in 16 patients (87.5% male), with a mean (± standard deviation) age of 14.3 (± 5.1) years. Eighteen cases of spontaneous pneumothorax were reported, fifteen of which primary (eleven first-time episodes and four recurrences) and three secondary (two first-time episodes and one recurrence) to asthma. Three cases of pneumomediastinum with subcutaneous emphysema were identified, two of which related to infection. Smoking habits and/or recent physical activity were major triggers. Pleuritic chest pain was the most frequent symptom on admission. Conservative treatment was the only approach used in six cases. Most cases required thoracic drainage, five of which required surgical intervention.
Discussion: This study shows similar demographic features, triggers, and clinical presentation to those reported in the literature for these cases. The management of the condition was based on recommendations established for adults.
Conclusion: Although spontaneous air leak is an uncommon condition, it is a reality in PED. Prospective studies in pediatric age are required to develop adequate recommendations for children and adolescents.
Mason R. Murray and Nadel’s Textbook of Respiratory Medicine. 4th ed. Elsevier Health Sciences; 2005. Chapter 72.
Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med 1939;64:913-26.
Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001;31:67-75.
Herlan DB, Landreneau RJ, Ferson PF. Massive spontaneous subcutaneous emphysema. Acute management with infraclavicular “blow holes”. Chest 1992;102:503-5.
Rao KL, Imamuddin S, Kumar AP. Isolated tension pneumopericardium in a case of acute lymphoblastic leukemia. Indian Heart J 2013;65:705-6.
Cummings RG, Wesly RL, Adams DH, Lowe JE. Pneumopericardium resulting in cardiac tamponade. Ann Thorac Surg. 1984;37(6):511-8.
El Gamel A, Barrett P, Kopff G. Pneumopericardium: a rare cause of cardiac tamponade in an infant on a positive pressure ventilation. Acta Paediatr 1994;83:1220-1.
Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think? Emerg Med J 2005;22:8-16.
Kliegman RM, Stanton BF, St Geme III JW, Schor NF. Nelson Tratado de Pediatría. 20ª edición. Elsevier, Barcelona, 2016. Vol. 2, Capítulo XIX, 2235-9.
Robinson P, Cooper P, Ranganathan S. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev. 2009;10:110-7.
Arribas PJ, López-Fernández S, Fernández AL, Burrieza GG, Roca JL. Neumotórax espontáneo en la edad pediátrica: factores asociados a su recidiva. Cir Pediatr 2015;28:200-4.
Dotson K, Johnson LH. Pediatric spontaneous pneumothorax. Pediatr Emerg Care 2012;28:715-20.
Davis AM, Wensley DF, Phelan PD. Spontaneous pneumothorax in paediatric patients. Respir Med 1993;87:531-4.
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;30:1452-4.
Poenaru D, Yazbeck S, Murphy S. Primary spontaneous pneumothorax in children. J Pediatr Surg 1994;29:1183-5.
Yellin A, Gapany-Gapanavicius M, Lieberman Y. Spontaneous pneumomediastinum: is it a rare cause of chest pain? Thorax 1983;38:383-5.
Dekel B, Paret G, Szeinberg A, Vardi A, Barzilay Z. Spontaneous pneumomediastinum in children: clinical and natural history. Eur J Pediatr 1996;155:695-7.
Jougon JB, Ballester M, Delcambre F, Bride TM, Dromer CEH, Velly JF. Assessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg 2003;75:1711-4.
Bodey, GP. Medical mediastinal emphysema. Ann Intern Med 1961;54:46-56.
Chiu C-Y, Chen T-P, Wang C-J, Tsai M-H, Wong K-S. Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients. Eur J Pediatr. 2014;173:1483-90.
McMahon DJ. Spontaneous pneumomediastinum. Am J Surg 1976;131:550-1.
Shih CH, Yu HW, Tseng YC, Chang Y-T, Liu C-M, Hsu J-W. Clinical manifestations of primary spontaneous pneumothorax in pediatric patients: an analysis of 78 patients. Pediatr Neonatol. 2011;52(3):150-4.
Soundappan SV, Holland AJ, Browne G. Sports-related pneumothorax in children. Pediatr Emerg Care 2005;21:259-60.
Partridge RA, Coley A, Bowie R, Woolard RH. Sports-related pneumothorax. Ann Emerg Med 1997;30:539-41.
Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-4.
Fitzwater JW, Silva NN, Knight CG, Malvezzi L, Ramos-Irizarry C, Burnweit CA, et al. Management of spontaneous pneumomediastinum in children. J Pediatr Surg 2015;50:983-6.
MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65, Suppl 2: ii18-31.
Lee LPY, Lai MHY, Chiu WK, Leung MWY, Liu KKW, Chan HB. Management of primary spontaneous pneumothorax in chinese children. Hong Kong Med J. 2010;16:94-100.
Noppen M, Keukeleire T. Pneumothorax. Respiration. 2008;76:121-7.
Herrmann D, Klapdor B, Ewig S, Hecker E. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience. Eur J Cardiothorac Surg 2016;49:854–9.
Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. CHEST 2005;127:2226–30.
Lamas-Pinheiro R, Branco-Salvador J, Jardim J, Ferraz C, Nunes T, Vaz LG, et al. Management of pediatric primary spontaneous pneumothorax in a tertiary hospital. Pulmonology Journal 2015;21(6):348-9.
Furia S, Breda C. Primary spontaneous pneumothorax in children and adolescents: a systematic review. Pediatr Med 2019. https://doi.org/10.21037/pm.2019.04.01.
Grabowski A, Korlacki W, Pasierbek M, Achtelik F. Thoracoscopy in the treatment of spontaneous pneumothorax in children. Polish Journal of Cardio-Thoracic Surgery 2013;10(4):369-73.
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