Nelson Textbook of Pediatrics 22nd Edition | Accumulation of air in pleural space. Primary spontaneous (tall thin males, subpleural blebs) vs secondary (CF, asthma, pneumonia, interstitial lung disease, trauma, iatrogenic, mechanical ventilation). Clinical: sudden chest pain, dyspnea, decreased breath sounds, hyperresonance, tachycardia, mediastinal shift (tension pneumothorax). Diagnosis: CXR (deep sulcus sign, mediastinal shift, visible visceral pleural line), ultrasound (lung point), CT. Treatment: observation (small, asymptomatic, primary spontaneous), needle aspiration, chest tube (for large, symptomatic, secondary, tension). Tension pneumothorax: immediate needle decompression (2nd intercostal space, midclavicular line). Recurrence prevention: pleurodesis (chemical or surgical), VATS blebectomy.
🌐 paeds.online — Pakistan's Pediatric Platform| Type | Management |
|---|---|
| Primary spontaneous, small (<2 cm), asymptomatic | Observation, supplemental O2, outpatient follow-up | Primary spontaneous, large (>2 cm) or symptomatic | Needle aspiration or small-bore chest tube |
| Secondary spontaneous | Chest tube (most require drainage), treat underlying disease |
| Tension pneumothorax | Immediate needle decompression (2nd ICS, MCL), then chest tube |
| Recurrent pneumothorax | Pleurodesis (chemical: doxycycline, talc; surgical: VATS with pleurectomy/blebectomy) |