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Primary Spontaneous Pneumothorax
Everything in the library about primary spontaneous pneumothorax — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Acute Management
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Spontaneous Pneumothorax
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This podcast is an interactive discussion about the management of spontaneous pneumothorax between Dr. Todd Ponsky and Dr. Dan Ostlie. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmi
podcast33:31 · Dec 2020
Evidence & Research
2 items
Management of Primary Spontaneous Pneumothorax in Children
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New article you should know about by Dr. Cecilia Gigena
"Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis"
Authors: Shai Stewart, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, Davi
video · Sep 2023
Journal of Pediatric Surgery Article REview: August Issue 2023
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 4 articles from August 2023 issue, with editor Dr. Holcomb, the expert Dr. Di Fiore and authors Drs. Krista Lai, Rega
podcast17:30 · Feb 2024
Case-Based Learning
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Spontaneous Pneumothorax: Lung Lesions
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Dr. Mark McCollum leads a discussion in the management of spontaneous pneumothorax, including the type of anesthesia for chest tube insertion, indications for CT scans, number of ports in VATS, recurrence of bilateral blebs, and different t
video22:21 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Spontaneous Pneumothorax: Lung Lesions
There is disagreement in the literature on management of primary spontaneous pneumothorax, with no clear evidence supporting any particular approach.
opinionMark0:09 ↗
The majority of children at their institution elect to undergo general anesthesia rather than bedside chest tube placement under local anesthesia.
clinicalMark6:23 ↗
50% of patients who undergo chest tube placement or observation for pneumothorax will have recurrence and need additional intervention.
epidemiologicalMark6:43 ↗
Among patients with bleb disease who undergo simple chest tube placement for symptomatic pneumothorax, upwards of 50% will recur.
epidemiologicalMark7:27 ↗
Second recurrence rate is approximately 75%.
epidemiologicalMark8:03 ↗
No study has separated patients on first event into those with blebs versus no blebs and examined risk of second event recurrence.
clinicalMark8:23 ↗
A CT scan is not very effective for visualizing blebs when the lung is partially collapsed.
clinicalMark8:45 ↗
Almost all patients with spontaneous pneumothorax have bleb disease whether it is defined early or not.
opinionMark13:14 ↗
Bleb disease does not necessarily mean recurrence will occur.
opinionMark13:28 ↗
Patients with spontaneous pneumothorax usually recur when at home, not in remote locations or extremis.
clinicalMark14:41 ↗
A recent study from Saint Peter in Kansas City found CT scan was very poor at defining bleb disease compared to subsequent thoracoscopy.
host_summaryMark13:00 ↗
More people are using chemical pleurodesis instead of mechanical pleurodesis and finding better results, shorter OR times, and decreased recurrence rates.
host_summaryMark19:08 ↗
There is still a pretty high recurrence rate even after VATS with blebectomy and mechanical or chemical pleurodesis.
clinicalMark19:08 ↗
In Argentina, for stable patients with pneumothorax, they place a thin double pigtail catheter percutaneously with local anesthesia, attached to a Heimlich valve.
clinicalMarcello9:04 ↗
Most patients with spontaneous pneumothorax are adolescents (around 18 years old).
clinicalMarcello5:12 ↗
Aerosolized talc can be administered through a chest tube, creating a 'snow' effect inside the chest for pleurodesis.
clinicalTodd20:03 ↗
Apical pleurectomy causes more postoperative pain than talc pleurodesis.
opinionTodd19:57 ↗
Talc pleurodesis creates random massive chemical pleurodesis throughout the chest, which may complicate future thoracic surgery.
host_summaryTodd20:23 ↗
Apical pleurectomy is limited to the apex of the lung, typically down to the third intercostal space when apical blebs are present.
host_summaryTodd20:33 ↗
When no blebs are visible on thoracoscopy, the apex can be sealed with a ligature and apical pleurectomy performed.
host_summaryTodd22:00 ↗
Hydrostatic pleurectomy technique involves making a small pleural incision, inserting a suction irrigator, sealing around it, and irrigating to dissect the entire pleura, which can then be rolled up and removed.
clinicalMark20:48 ↗
Hydrostatic pleurectomy can achieve hemi-thorax pleural removal, more extensive than apical pleurectomy alone.
clinicalMark21:11 ↗
After unilateral treatment of symptomatic pneumothorax, recurrence can occur on the contralateral side during the immediate postoperative period.
clinicalGiovanna17:51 ↗
Spontaneous Pneumothorax
Primary spontaneous pneumothorax is more common in males by approximately 3 to 1 ratio
epidemiologicalDan Osley1:42 ↗
CT scan data fairly convincingly shows that it is probably not beneficial with regard to changing treatment parameters or outcomes for spontaneous pneumothorax
clinicalDan Osley3:05 ↗
In multi-institutional retrospective trial, chest tubes worked about 50% of the time for spontaneous pneumothorax
clinicalDan Osley3:32 ↗
The failure rate for patients who get a chest tube and resolve is about 50% - they will be back and have to have another operation
clinicalDan Osley5:00 ↗
Patients who get a chest tube and fail in the hospital and subsequently go on to VATS still have a failure rate of around 25 to 30%
clinicalDan Osley5:24 ↗
Patients who get immediate VATS have about a 10 to 15% failure rate
clinicalDan Osley8:02 ↗
Patients who get a chest tube and then VATS have higher failure rates (25%) than those who get immediate VATS, possibly because they are predisposed to recurrence
clinicalDan Osley8:23 ↗
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