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Baban A, Parlapiano G, Cicenia M, Armando M, Franceschini A, Pacifico C, Panfili A, Zinzanella G, Romanzo A, Fusco A, Caiazza M, Perri G, Galletti L, Digilio MC, Buonuomo PS, Bartuli A, Novelli A, Raponi M, Limongelli G. Unique Features of Cardiovascular Involvement and Progression in Children with Marfan Syndrome Justify Dedicated Multidisciplinary Care. J Cardiovasc Dev Dis 2024; 11:114. [PMID: 38667733 PMCID: PMC11050181 DOI: 10.3390/jcdd11040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Marfan syndrome (MIM: # 154700; MFS) is an autosomal dominant disease representing the most common form of heritable connective tissue disorder. The condition presents variable multiorgan expression, typically involving a triad of cardiovascular, eye, and skeletal manifestations. Other multisystemic features are often underdiagnosed. Moreover, the disease is characterized by age related penetrance. Diagnosis and management of MFS in the adult population are well-described in literature. Few studies are focused on MFS in the pediatric population, making the clinical approach (cardiac and multiorgan) to these cases challenging both in terms of diagnosis and serial follow-up. In this review, we provide an overview of MFS manifestations in children, with extensive revision of major organ involvement (cardiovascular ocular and skeletal). We attempt to shed light on minor aspects of MFS that can have a significant progressive impact on the health of affected children. MFS is an example of a syndrome where an early personalized approach to address a dynamic, genetically determined condition can make a difference in outcome. Applying an early multidisciplinary clinical approach to MFS cases can prevent acute and chronic complications, offer tailored management, and improve the quality of life of patients.
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Affiliation(s)
- Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Marianna Cicenia
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.); (A.F.)
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy;
| | - Alessio Franceschini
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.); (A.F.)
| | - Concettina Pacifico
- Audiology and Otosurgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Arianna Panfili
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Gaetano Zinzanella
- Ophthalmology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.Z.); (A.R.)
| | - Antonino Romanzo
- Ophthalmology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.Z.); (A.R.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.P.); (L.G.)
| | - Lorenzo Galletti
- Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.P.); (L.G.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Paola Sabrina Buonuomo
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Andrea Bartuli
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
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Aker C, Selin Onay M, Cansever L. Pneumothorax and pneumomediastinum in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S37-S42. [PMID: 38584791 PMCID: PMC10995689 DOI: 10.5606/tgkdc.dergisi.2024.25755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/21/2023] [Indexed: 04/09/2024]
Abstract
Pneumothorax is a condition that describes the presence of air between the visceral and parietal pleura sheets and the consequent collapse of the lungs. The collapse of the lungs can be partial or total and can present in different clinical stages, such as a high-pressure pneumothorax that can cause a mediastinal shift. Pneumomediastinum is the presence of free air between the mediastinal tissues due to various causes. It can manifest spontaneously and be minimally symptomatic but can also develop due to severe complications. Its etiology includes numerous iatrogenic and traumatic factors. Although spontaneous pneumothorax and pneumomediastinum that develop in childhood are similar to adult patients, it is important to determine the appropriate treatment strategy in addition to the age group, the effectiveness of the treatment, the role of the applied treatment in reducing recurrence, and the etiologyoriented treatments if there is an underlying pathology.
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Affiliation(s)
- Cemal Aker
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Mahmuti Selin Onay
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Levent Cansever
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
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Şahin C, Ayyıldız HNK, Mirapoğlu S, Güvenç FT, Akis Yıldız Z, Arpacik M, Kaymakçı A, Ilce Z. Use of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Spontaneous Pneumothorax (PSP) in Children. Cureus 2023; 15:e42624. [PMID: 37641772 PMCID: PMC10460625 DOI: 10.7759/cureus.42624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature. METHODS The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study. RESULTS The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months. CONCLUSION Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.
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Affiliation(s)
- Ceyhan Şahin
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | | | - Semih Mirapoğlu
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Fatma Tuğba Güvenç
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Zeliha Akis Yıldız
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Mehmet Arpacik
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Aytekin Kaymakçı
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Zekeriya Ilce
- Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
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Stewart S, Fraser JA, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, Oyetunji TA, St Peter SD. Management of primary spontaneous pneumothorax in children: A single institution protocol analysis. J Pediatr Surg 2023:S0022-3468(23)00075-1. [PMID: 36803908 DOI: 10.1016/j.jpedsurg.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/13/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol. METHODS A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed. RESULTS Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01]. CONCLUSION Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity. LEVEL OF EVIDENCE IV. Retrospective study.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Engwall-Gill AJ, Weller JH, Rahal S, Etchill E, Kunisaki SM, Nasr IW. Early risk factors of operative management for hospitalization children with spontaneous pneumothorax. J Pediatr Surg 2022; 57:994-999. [PMID: 35649747 DOI: 10.1016/j.jpedsurg.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal timing of operative management in children with primary spontaneous pneumothorax (PSP) remains controversial. This study sought to determine early risk factors for failure of chest tube nonoperative management during the initial hospitalization in adolescents with PSP. METHODS A retrospective review was conducted for children (aged ≤18 years) admitted to a single tertiary care referral center for their first presentation of a PSP managed with at least 48 h of chest tube decompression (CTD) alone. Patient outcomes and early risk factors for operative management were analyzed by multivariate regression. RESULTS Of the 39 patients who met inclusion criteria, 15 (38.5%) patients failed nonoperative treatment while 24 (61.5%) patients were managed with CTD therapy alone. Progression to thoracoscopic surgery was associated with longer CTD of 8 vs 3 days and hospital length of stay of 9 vs 4 days when compared to nonoperative management (p < 0.001, both). Air leak and increase in pneumothorax size at 24 h after CTD were independently associated with progression to surgery (p = 0.007, p = 0.002). Combined, these risk factors were associated with a significant increase in recurrence (OR 6.00, 95% CI 1.11-41.11, p = 0.048). There were no significant differences between PSP management strategies regarding cumulative radiation exposure or 2 year recurrence. CONCLUSIONS Air leak or increasing pneumothorax size within 24 h of CTD are highly correlated with failed nonoperative management during the initial hospitalization in pediatric patients with PSP. This data may be useful in the development of pediatric-specific treatment algorithms to optimally manage these patients. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA.
| | - Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Simon Rahal
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Eric Etchill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Isam W Nasr
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
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Yousuf S, Cardenas S, Rezaee F. Pediatric pneumothorax: Case studies and review of current literature. Respir Med Case Rep 2021; 34:101548. [PMID: 34820257 PMCID: PMC8602041 DOI: 10.1016/j.rmcr.2021.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Pneumothorax is an abnormal collection of air between the lung and chest wall. Pneumothorax management guidelines put forth by the American College of Chest Physicians, European Respiratory Society, and British Thoracic Society are specific to adult patients. These guidelines' utility has not been addressed in pediatric populations, which causes significant management variation in younger patients. Additionally, pneumothorax management ranges from conservative to surgical treatment, but these approaches, timelines, and effectiveness have not been validated in significant numbers of pediatric patients. Here, we present three cases of pediatric pneumothorax with variable clinical courses—one with persistent air leak despite chest tube presence who underwent VATS and surgical resection of apical blebs. In contrast, the other two cases were managed more conservatively. We reviewed the current literature for diagnostic and management of pediatric patients with pneumothorax, which underscores the need for guidelines specific to this population.
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Affiliation(s)
- Shahwar Yousuf
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Silvia Cardenas
- Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Fariba Rezaee
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Rajvanshi N, Natarajan V, Sahai R, Kumar M, Sharawat IK, Bolia R. Recurrent pneumothorax in a child. J Paediatr Child Health 2021; 57:738-740. [PMID: 32757340 DOI: 10.1111/jpc.15015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nikhil Rajvanshi
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Vivekanand Natarajan
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Rishabh Sahai
- Pathology, All India Institute of Medical sciences, Rishikesh, India
| | - Manish Kumar
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Indar Kumar Sharawat
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
| | - Rishi Bolia
- Department of Paediatrics, All India Institute of Medical sciences, Rishikesh, India
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Lin CH, Lin CL, Lin WC, Wei CC. Long-term risk of pneumothorax in asthmatic children: A 12-year population-based cohort study. Medicine (Baltimore) 2020; 99:e23779. [PMID: 33371147 PMCID: PMC7748327 DOI: 10.1097/md.0000000000023779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Pneumothorax is a life-threatening complication during acute asthma attack. However, long-term risk of pneumothorax in asthmatic children remains unknown.In this retrospective cohort study, 333,657 children were defined as asthma cohort and a 1:1 matched non-asthma cohort were generated from 2000 to 2011. At the end of 2012, the incidence of pneumothorax in asthma and non-asthma cohorts and asthma to non-asthma hazard ratios (HRs) with confidence intervals (CIs) of pneumothorax were analyzed.The incidence of pneumothorax was 1.35-fold higher in the asthma cohort than that in the non-asthma cohort. The asthma to non-asthma HRs of pneumothorax were higher in children younger than 6 years (1.76, 95% CI: 1.21-2.57) and in girls (2.27; 95% CI: 1.23-4.16). The HRs of pneumothorax were higher in asthmatic children with more asthma-related out-patient clinic visits/per year (>5 visits; HR: 2.81; 95% CI: 1.79-4.42), more emergency department visits/per year (>4 visits; HR: 1.68; 95% CI: 1.02-2.78), and longer hospitalization days due to asthma (>4 days; HR: 3.42; 95% CI: 1.52-6.94) (P < .0001, the trend test).Asthmatic children had greater risk for pneumothorax, particularly in young children and in those with severe and uncontrolled asthma.
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Affiliation(s)
- Chien-Heng Lin
- Children's Hospital, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Wei-Ching Lin
- School of Medicine, China Medical University
- Department of Radiology, China Medical University Hospital
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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Akıncı SM, Soyer T, Yalçın Ş, Ekinci S, Karnak İ, Çiftçi AÖ, Tanyel FC. The results and outcome of primary spontaneous pneumothorax in adolescents. Int J Adolesc Med Health 2020; 33:127-131. [PMID: 32549138 DOI: 10.1515/ijamh-2018-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/09/2018] [Indexed: 11/15/2022]
Abstract
AIM Primary spontaneous pneumothorax (PSP) is a rare pulmonary pathology that occurs in the absence of known lung disease. A retrospective study was performed to evaluate the results and outcome of PSP treatment in adolescents. METHODS The cases with PSP from January 2004 to December 2017 were evaluated for age, sex, family and smoking history, clinical and radiological findings and results of treatment. RESULTS Ten cases with PSP were included. The mean age of the patients was 15 years (10-17 years) and the male to female ratio was 9:1. Two of the patients (20%) had family history of PSP and four cases (40%) had smoking history. The initial complaints were chest pain (n=8), acute onset of cough (n=1) and breathing difficulty (n=1). Tube thoracostomy was performed in nine cases in which three of them were bilateral. Chest computed tomography (CT) demonstrated bullae (n=4; 40%) and subpleural blebs (n=2; 20%). Pleurodesis with talc was performed in four patients with pneumothorax for longer than a week in follow-up (n=4; 40%). Five cases had recurrent PSP within one year (n=5; 50%) and underwent pleurodesis with talc (n=4), autologous-blood (n=1) and bleomycin (n=1). Bleb excision was performed in two cases with persistent pneumothorax despite pleurodesis. CONCLUSION Tube thoracostomy and oxygen supplementation, are considered as initial and adequate treatment of PSP in most of the adolescents. Prolonged air leaks require pleurosdesis as the first line treatment and surgical excision of blebs should be reversed for the patients who are unresponsive to other treatment options.
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Affiliation(s)
- Servet Melike Akıncı
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Şule Yalçın
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Arbay Özden Çiftçi
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Pogorelić Z, Gudelj R, Bjelanović D, Jukić M, Elezović Baloević S, Glumac S, Furlan D. Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery. J Laparoendosc Adv Surg Tech A 2020; 30:569-575. [PMID: 32167851 DOI: 10.1089/lap.2019.0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Treatment of pneumothorax involves conservative treatment and surgery. The aim of this study was to assess the best approach of initial treatment and long-term outcomes of video-assisted thoracic surgery (VATS) for primary spontaneous pneumothorax in pediatric patients. Patients and Methods: From January 2009 until June 2019, 36 patients younger than the age of 18 who were treated for spontaneous pneumothorax were included into retrospective study. Patients were divided into 2 groups, non-VATS and VATS, depending on the way they were treated. The groups were compared regarding demographic and clinical data and outcomes of treatment (the length of hospitalization, the frequency of postoperative complications, and reoperations). Results: Out of 36 patients, there were 24 boys and 12 girls with median age of 16.5 years. Median duration of hospitalization was 8 days. Eight patients were treated by observation and 28 by chest tube insertion. In 14 patients with spontaneous pneumothorax, VATS was performed [indications were persistent air leak in 8 (57%) and recurrent pneumothorax in 6 (43%) children]. Patients who underwent surgery had significantly higher length of hospitalization (P < .001) and lower rate of recurrences (P = .003) than those who did not. In 12 (86%) patients, blebs were found intraoperative, and in all of them, pleurodesis was performed. Duration of chest tube insertion was significantly longer in patients who experienced recurrent pneumothorax (P < .001). Conclusions: VATS is successful, efficient, and safe method of treatment for spontaneous pneumothorax, due to its significantly lower rate of recurrence in comparison with chest tube insertion.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Ružica Gudelj
- Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Dora Bjelanović
- Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | | | - Sandro Glumac
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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11
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Williams K, Baumann L, Grabowski J, Lautz TB. Current Practice in the Management of Spontaneous Pneumothorax in Children. J Laparoendosc Adv Surg Tech A 2018; 29:551-556. [PMID: 30592692 DOI: 10.1089/lap.2018.0629] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. MATERIALS AND METHODS An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. RESULTS A total of 287 surveys were completed (33% response rate). For a first episode of PSP, 57% of surgeons opt for chest tube drainage, 4% for upfront video-assisted thoracoscopic surgery (VATS), 3% for needle aspiration, and 29% for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40% operating after 3 days, but 21% waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. CONCLUSION There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.
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Affiliation(s)
- Kibileri Williams
- 1 Department of Surgery, Howard University Hospital, Washington, District of Columbia.,2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren Baumann
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,3 Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Julia Grabowski
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B Lautz
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Williams K, Lautz TB, Leon AH, Oyetunji TA. Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. J Pediatr Surg 2018; 53:1858-1861. [PMID: 29277465 DOI: 10.1016/j.jpedsurg.2017.11.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no consensus in the pediatric surgical community about when to recommend video-assisted thoracoscopic surgery (VATS) for patients with primary spontaneous pneumothorax (PSP). We aimed to identify factors that predict the likelihood of requiring VATS, and to compare recurrence rates and healthcare utilization among different management approaches to PSP. METHODS A retrospective chart review and a telephone survey were conducted on all patients 12-21years who were diagnosed with PSP from 2007 to 2015. Data were extracted on patient demographics, initial management, hospital length of stay (LOS), and subsequent admissions, procedures, and recurrences. RESULTS A total of 46 patients were included with a mean age of 16.1years (+/- 1.2). Most patients were male (41, 89%) and white (16, 44%). Initial management comprised chest tube drainage alone in 28 (61%), no intervention in 8 (17%), and VATS in 10 (22%). Total LOS was 6days (IQR 4-7) and was longer in patients who underwent VATS (p<0.001). Recurrence occurred in 17 patients (37%). However, recurrence and healthcare utilization were not significantly associated with initial management approach. Among those who had initial chest tube drainage, 14 (50%) underwent VATS on that admission, and 8 (28%) had subsequent surgery. Significant predictors of ultimately requiring VATS were presence of an air leak and partial lung expansion. CONCLUSION Most patients with PSP currently undergo chest tube placement as initial management, although most eventually require VATS. Presence of an air leak and partial lung expansion on chest radiograph within the first 48h of management should prompt earlier surgical intervention. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kibileri Williams
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Timothy B Lautz
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Astrid H Leon
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611
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13
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Nong BR, Kuo PY, Huang YF, Chiou YH. Primary spontaneous pneumothorax in children: A literature review. ACTA ACUST UNITED AC 2018. [DOI: 10.4103/prcm.prcm_3_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Pathak V, Quinn C, Zhou C, Wadie G. Use of autologous blood patch for prolonged air leak in spontaneous pneumothoraces in the adolescent population. Lung India 2018; 35:328-331. [PMID: 29970773 PMCID: PMC6034386 DOI: 10.4103/lungindia.lungindia_462_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Instillation of an autologous blood patch for prolonged air leak (PAL) in chest tube system has been studied and determined to be a safe and effective treatment plan for adults. The current recommended treatment guidelines for a PAL in adolescent secondary to a spontaneous pneumothorax are surgical intervention. This paper serves as documentation of two case reports with successful treatment of PALs with autologous blood patch in two adolescent patients.
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Affiliation(s)
- Vikas Pathak
- Department of Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington; Department of Pulmonary and Critical Care, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Caitlin Quinn
- Department of Pulmonary and Critical Care, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Christine Zhou
- Department of Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - George Wadie
- Department of Pulmonary and Critical Care; Department of Pediatric Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
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15
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Williams K, Oyetunji TA, Hsuing G, Hendrickson RJ, Lautz TB. Spontaneous Pneumothorax in Children: National Management Strategies and Outcomes. J Laparoendosc Adv Surg Tech A 2017; 28:218-222. [PMID: 29237135 DOI: 10.1089/lap.2017.0467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The timing of surgical intervention in the management of spontaneous pneumothorax remains controversial. The aim of this multicenter review was to compare management strategies and outcomes in children with spontaneous pneumothorax. METHODS We retrospectively reviewed patients 10-19 years old in the Pediatric Health Information System admitted for spontaneous pneumothorax from 2010 to 2014. Three treatment groups were identified based on initial hospital management-no intervention, initial chest tube placement, and operation; and outcomes were compared. RESULTS A total of 1040 patients were included. The majority were male (82.1%) and White (71.1%). The mean age at first encounter was 15.7 ± 1.7 years. Initial treatment included no intervention in 336 (32.3%), chest tube in 497 (47.8%), and video-assisted thoracoscopic surgery (VATS) in 207 (19.9%). Ultimately, 417 (40.1%) patients underwent VATS during the initial admission and 559 (53.8%) during the initial admission or a subsequent encounter. Aggregate length of stay (LOS) was highest for those treated initially with chest tube alone (P < .001). For patients managed initially with chest tube, the probability of requiring surgery increased with each day of hospitalization. Initial operation was associated with a decreased risk of readmission (OR 0.67, 95% CI 0.50-0.90). Estimated adjusted hospital costs, aggregated across all encounters, were highest for chest tube alone (P < .001). CONCLUSION Early VATS is associated with decreased hospital LOS, charges, and readmissions. For those managed initially with chest tube alone, the likelihood of requiring operation increases with each day hospitalized, and early conversion to operative management should be considered in patients with persistent pneumothorax or air leak.
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Affiliation(s)
- Kibileri Williams
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Tolulope A Oyetunji
- 3 Department of Surgery, Children's Mercy Kansas City , Kansas City, Missouri
| | - Grace Hsuing
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | | | - Timothy B Lautz
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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16
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Yeung F, Chung PHY, Hung ELY, Yuen CS, Tam PKH, Wong KKY. Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why? J Laparoendosc Adv Surg Tech A 2017; 27:841-844. [PMID: 28099064 DOI: 10.1089/lap.2016.0163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. MATERIALS AND METHODS We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. RESULTS A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). CONCLUSION Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.
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Affiliation(s)
- Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Patrick H Y Chung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Esther L Y Hung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Chi Sum Yuen
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Paul K H Tam
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Kenneth K Y Wong
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
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Robinson PD, Blackburn C, Babl FE, Gamage L, Schutz J, Nogajski R, Dalziel S, Donald CB, Druda D, Krieser D, Neutze J, Acworth J, Lee M, Ngo PK. Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series. Arch Dis Child 2015; 100:918-23. [PMID: 25670402 DOI: 10.1136/archdischild-2014-306696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/19/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Paediatric guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations. METHODS Retrospective analysis of PSP and SSP management at nine paediatric emergency departments across Australia and New Zealand (2003-2010) to compare PSP and SSP management. RESULTS 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), p<0.05. An intercostal chest catheter (ICC) was used in 104/219 (47%) episodes. Aspiration was used in more PSP than in SSP episodes with interventions (27% (18% to 37%) vs 9% (3% to 21%), p<0.05). Aspiration success was 52% (33% to 70%) overall and not significantly different between PSP and SSP. Aspiration success was greater in small vs large pneumothoraces (80% (48% to 95%) vs 33% (14% to 61%), p=0.01). Small-bore ICCs were used in 40% of ICCs and usage increased during the study. CONCLUSIONS In this descriptive study of pneumothorax management, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. Paediatric prospective studies are urgently required to determine optimal paediatric interventional management strategies.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Carol Blackburn
- Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
| | - Lalith Gamage
- Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia
| | - Jacquie Schutz
- Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia
| | - Rebecca Nogajski
- Emergency Department, Sydney Children's Hospital, Sydney, Australia
| | - Stuart Dalziel
- Starship Hospital, Auckland, New Zealand Liggins Institute, University of Auckland, New Zealand
| | | | - Dino Druda
- Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia
| | - David Krieser
- Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Medicine Department, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand
| | - Jason Acworth
- Emergency Medicine Department, Royal Children's Hospital, Brisbane, Australia
| | - Mark Lee
- Emergency Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Peter K Ngo
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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18
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Lamas-Pinheiro R, Branco-Salvador J, Jardim J, Ferraz C, Nunes T, Vaz LG, Azevedo I, Henriques-Coelho T. Management of pediatric primary spontaneous pneumothorax in a tertiary hospital. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:S2173-5115(15)00130-X. [PMID: 26227223 DOI: 10.1016/j.rppnen.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 06/04/2023] Open
Affiliation(s)
- R Lamas-Pinheiro
- Department of Pediatric Surgery, Hospital São João, Faculty of Medicine, Porto, Portugal.
| | - J Branco-Salvador
- Department of Pediatric Surgery, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - J Jardim
- Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - C Ferraz
- Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - T Nunes
- Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - L G Vaz
- Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - I Azevedo
- Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal
| | - T Henriques-Coelho
- Department of Pediatric Surgery, Hospital São João, Faculty of Medicine, Porto, Portugal
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19
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Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice? Am J Surg 2014; 208:571-6. [DOI: 10.1016/j.amjsurg.2014.06.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 01/03/2023]
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20
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Johannesma PC, van den Borne BEEM, Gille JJP, Nagelkerke AF, van Waesberghe JTM, Paul MA, van Moorselaar RJA, Menko FH, Postmus PE. Spontaneous pneumothorax as indicator for Birt-Hogg-Dubé syndrome in paediatric patients. BMC Pediatr 2014; 14:171. [PMID: 24994497 PMCID: PMC4088368 DOI: 10.1186/1471-2431-14-171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/27/2014] [Indexed: 12/12/2022] Open
Abstract
Background Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominantly inherited disorder caused by germline mutations in the folliculin (FLCN) gene. Clinical manifestations of BHD include skin fibrofolliculomas, renal cell cancer, lung cysts and (recurrent) spontaneous pneumothorax (SP). All clinical manifestations usually present in adults > 20 years of age. Case presentations Two non-related patients with (recurrent) pneumothorax starting at age 14 accompanied by multiple basal lung cysts on thoracic CT underwent FLCN germline mutation analysis. A pathogenic FLCN mutation was found in both patients confirming suspected BHD. The family history was negative for spontaneous pneumothorax in both families. Conclusion Although childhood occurrence of SP in BHD is rare, these two cases illustrate that BHD should be considered as cause of SP in children.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007, MB Amsterdam, The Netherlands.
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21
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Tsou KC, Huang PM, Hsu HH, Chen KC, Kuo SW, Lee JM, Chang YC, Chen JS, Lai HS. Role of computed tomographic scanning prior to thoracoscopic surgery for primary spontaneous pneumothorax. J Formos Med Assoc 2014; 113:606-11. [PMID: 24709294 DOI: 10.1016/j.jfma.2014.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE The role computed tomography (CT) performed prior to thoracoscopic surgery for primary spontaneous pneumothorax (PSP) remains unclear. METHODS We retrospectively reviewed medical records of all patients who underwent thoracoscopic surgery for PSP during 2008-2012. Patients were stratified into two groups: CT group (patients who received preoperative CT scanning) and control group (patients who did not receive preoperative scanning). Short-term postoperative results and long-term pneumothorax recurrence rates were compared. RESULTS A total of 298 patients were studied. Preoperative CT scanning was performed in 140 of them. The duration of operation, incidence of bullae formation, number of excised specimens, rate of complications, and postoperative hospital stay were similar between the two groups. After a mean follow-up of 20 months, the recurrence rates were 8.6% (12/140) in the CT group and 5.7% (9/158) in the control group (p = 0.371). In the CT group, five patients had unexpected pulmonary findings and three of them (60%) developed pneumothorax recurrence, the rate of which was significantly higher than that in patients without unexpected pulmonary findings (9/135, 6.7%, p = 0.004). Unexpected pulmonary lesions were more commonly noted in females (4/19, 21.1%) than in males (1/121, 0.8%; p < 0.001). CONCLUSION Preoperative CT scanning was not associated with better results after thoracoscopic surgery for PSP and is, therefore, not justified as a routine examination prior to the operation. In female patients, however, preoperative CT scanning might be needed because these patients tended to have a higher incidence of unexpected pulmonary lesions, which were associated with a higher rate of recurrence.
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Affiliation(s)
- Kuan-Chuan Tsou
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Lee SJ, Cha MA, Woo YR, Kwon EB, Ahn YH. Clinical characteristics of primary spontaneous pneumothorax in adolescents: factors for recurrence. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.4.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Seung Joon Lee
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Min A Cha
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeol Ryoon Woo
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Eun Byul Kwon
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeon Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
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23
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Viveiro C, Rocha P, Carvalho C, Zarcos MM. Spontaneous pneumothorax as manifestation of Marfan syndrome. BMJ Case Rep 2013; 2013:bcr-2013-201697. [PMID: 24311428 DOI: 10.1136/bcr-2013-201697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors describe a 16-year-old boy, previously healthy, who was admitted to our hospital for left-sided spontaneous pneumothorax. On physical examination he presented with marfanoid habitus. Pneumothorax was managed conservatively with resolution. Four months later he had a recurrence of left-sided pneumothorax and 1 week after that he presented with contralateral pneumothorax. He underwent video-assisted thoracoscopic surgery twice for bullectomy and pleurodesis. No further recurrence was stated. Additional investigation showed a prolapsed cardiac mitral valve and Marfan syndrome was confirmed genetically.
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Affiliation(s)
- Carolina Viveiro
- Department of Pediatria, Centro Hospitalar de Leiria-Pombal, Leiria, Portugal
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Young Choi S, Beom Park C, Wha Song S, Hwan Kim Y, Cheol Jeong S, Soo Kim K, Hyon Jo K. What factors predict recurrence after an initial episode of primary spontaneous pneumothorax in children? Ann Thorac Cardiovasc Surg 2013; 20:961-7. [PMID: 24284502 DOI: 10.5761/atcs.oa.13-00142] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals. METHODS We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011. RESULTS One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence. CONCLUSION The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.
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Affiliation(s)
- Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Bourne CL. The perils of sneezing: Bilateral spontaneous pneumothorax. J Emerg Trauma Shock 2013; 6:138-9. [PMID: 23723627 PMCID: PMC3665065 DOI: 10.4103/0974-2700.110796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022] Open
Abstract
This is a brief case report of an adolescent male who developed bilateral spontaneous pneumothorax after sneezing.
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Affiliation(s)
- Christina L Bourne
- Department of Internal Medicine, Division of Emergency Medicine, Medical University of South Carolina, USA
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Seguier-Lipszyc E, Elizur A, Klin B, Vaiman M, Lotan G. Management of primary spontaneous pneumothorax in children. Clin Pediatr (Phila) 2011; 50:797-802. [PMID: 21482575 DOI: 10.1177/0009922811404699] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the role of CT scans and early surgical intervention in the management of pediatric patients with primary spontaneous pneumothorax (PSP). METHODS Retrospective cohort study. RESULTS The authors identified 46 cases with 70 episodes of pneumothorax. The recurrence rate among conservatively treated patients was 50% both after the first and the subsequent episode. Recurrence rate in cases with and without blebs on CT was comparable. Initial episodes were treated with supplemental oxygen (n = 18) and chest tube drainage (n = 18), and 10 patients underwent video-assisted thoracoscopic surgery (VATS). The recurrence rate was significantly lower following surgical intervention compared with other therapy, and morbidity was comparable with that in patients who needed chest tube drainage. CONCLUSIONS Recurrence after the first episode of PSP in children is frequent and is difficult to predict by CT findings. VATS is safe and effective in preventing recurrences. Surgical intervention may be an attractive alternative in patients who require chest tube drainage for the first episode of PSP.
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Savasta S, Leoni MC, Strocchio L, Pizzo D, Spartà MV, Lima M, Valli M, Marchi A. A rare cause of recurrent spontaneous pneumothorax. Clin Pediatr (Phila) 2011; 50:456-8. [PMID: 21525091 DOI: 10.1177/0009922810385571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Salvatore Savasta
- Fondazione IRCCS Policlinico San Matteo, viale Golgi 2, University of Pavia, Pavia, Italy.
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Abstract
PURPOSE OF REVIEW Secondary spontaneous pneumothorax (SSP) can occur in patients who are suffering from diffuse lung disease. The main cause of SSP is chronic obstructive pulmonary disease (COPD). In contrast to primary spontaneous pneumothorax, SSP is a potentially life-threatening condition because patients with SSP also have limited cardiopulmonary reserve. Prompt diagnosis and treatment of SSP are mandatory. In this review, thoracoscopy, a less invasive surgical treatment for SSP, is discussed from the viewpoint of postoperative morbidity, mortality, and recurrence of SSP. RECENT FINDINGS A meta-analysis showed that postoperative recurrence of pneumothorax is more frequently observed following thoracoscopy than following open thoracotomy. Recent studies on thoracoscopic surgery for SSP have shown that the rate of postoperative morbidity is still high (15-27.7%) and thoracoscopy is sometimes replaced with open thoracotomy because of dense pleural adhesion or inability to maintain one-lung ventilation during surgery. However, many thoracic surgeons prefer to perform thoracoscopic surgery for SSP because it is less invasive than open thoracotomy. Techniques for bullectomy and pleurodesis are currently being adapted to decrease the recurrence rate of pneumothorax. SUMMARY Thoracoscopic surgery for the treatment of SSP should be less invasive to reduce postoperative morbidity, and it should also be more effective to reduce the recurrence of pneumothorax.
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Lee CY, Wu CC, Lin CY. Etiologies of spontaneous pneumomediastinum in children in middle Taiwan. Pediatr Pulmonol 2010; 45:869-73. [PMID: 20687204 DOI: 10.1002/ppul.21124] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SUMMARY INTRODUCTION Spontaneous pneumomediastinum (SPM), while rare, is probably underestimated in children. Treatment targets on the underlying disease and trigger factors. The study aimed in analysis different etiology in different age groups. PATIENTS AND METHODS Total 37 children with SPM were analyzed from two medical centers in middle Taiwan from 1994 to 2007. RESULTS Incidence of SPM in children was 1:11,726 patients at Department of Pediatric Emergency in middle Taiwan. Bimodal peak in incidence occurred in those under 7 and in those aged 15-18 years old. The Characteristic symptoms were dyspnea (64.9%), followed by chest pain (62.2%) and neck pain (40.5%); common specific physical signs were subcutaneous emphysema (SCE) (67.6%) and Hammer's sign (13.5%). Trigger factors were infection (43.2%), asthma (21.0%), esophageal rupture (5.4%), foreign body aspiration (2.7%), and diabetic ketoacidosis (2.7%). Idiopathic SPM accounted for 35.1% of patients with mean age 14.1 years. In age distribution, preschoolers (<7 years old) got SPM mostly due to lower respiratory tract infection. In adolescents, the most common etiologies were asthma and upper respiratory tract infection. Mean hospitalization was 6.4 days. Although 17 (46.0%) patients needed intensive care, nearly all had complete resolution in chest radiography before discharge. CONCLUSION Clinician should keep alert to incidence of SPM from these symptoms. Etiologies varied with age and treatment must target on factors and underlying disease.
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Affiliation(s)
- Chia-Ying Lee
- Department of Pediatrics, Children's Medical Center, China Medical University Hospital, Taichung, Taiwan
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Žganjer M, Čizmić A, Pajić A, Cigit I, Žganjer V. Primary Spontaneous Pneumothorax in Pediatric Patients: Our 7-Year Experience. J Laparoendosc Adv Surg Tech A 2010; 20:195-8. [DOI: 10.1089/lap.2009.0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mirko Žganjer
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ante Čizmić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Anto Pajić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Irenej Cigit
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
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Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev 2009; 10:110-7; quiz 117. [PMID: 19651381 DOI: 10.1016/j.prrv.2008.12.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The exact incidence of paediatric primary spontaneous pneumothorax (PSP) is unclear, although PSP incidence in the general population is between 6 and 18 per 100,000. PSP has been reported throughout the paediatric age range. A potential genetic predisposition for familial cases has been recently identified. Whilst there is universal consensus on the management of tension pneumothorax, lack of agreement and consistency exists across a wide range of management issues for other aspects of PSP management. Paediatric PSP may have a higher recurrence rate than adult PSP, and the presence of apical lung cysts or bullae is not predictive of recurrence. The decision for surgical intervention should be based on documented recurrence. There is a lack of paediatric evidence to guide management decisions, and extrapolation of predominantly adult data to younger age groups should not be encouraged. Given the relatively low apparent incidence, a multicentre approach to future research is required in order to generate the evidence required for informed management of PSP in children.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, NSW, 2145 Australia.
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Abstract
INTRODUCTION Primary spontaneous pneumothorax is a condition that carries significant morbidities and mortalities if not managed properly. Thoracotomy with bullectomy has been the treatment of choice for persistent air leak or recurrence after initial chest drain insertion. With the advancement in minimal invasive surgery, the thoracoscopic approach can dramatically reduce the complications of open thoracotomy. We review our experience in managing spontaneous pneumothorax in children using thoracoscopy. MATERIALS AND METHODS The medical records of all patients who were discharged with the diagnosis of spontaneous pneumothorax from 1997 to 2007 were reviewed. The demographic data and management were noted. For those patients who underwent thoracoscopic surgery, the intra-operative findings, post-operative outcomes and complications were compared. RESULTS A total of 15 patients with spontaneous pneumothorax were identified. They all received chest drain insertion as the primary treatment modality. Nine patients, with mean age 16.1 +/- 0.9 years, failed the initial management and subsequently received thoracoscopic surgery with a mean interval of 7.6 +/- 2.5 days after initial chest drain insertion. Among these patients, bullae were found in seven patients (two patients had more than one bulla). The bullae were excised with mean operative time being 63.9 +/- 25.2 min. No conversion to thoracotomy was reported. All patients received paracetamol as pain control and there was no associated complication. No recurrence was found at follow-up till now. CONCLUSION This study confirms that the presence of bulla is commonly seen in patients with spontaneous pneumothorax who fail initial management. Thoracoscopic bullectomy, a safe and effective operation, should be offered to this group of patients.
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