Collection
Thoracic Surgery in Children
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
Once empyema is defined with loculations and high white cell count, antibiotics alone are probably not the right choice and intervention is needed to remove fibrinous exudate — Dan Osley, Panel discussion on fibrinolytic therapy versus VATS for pediatric empyema management · 3:59
Fibrinolysis vs VATS3 items
Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children
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Introduction: We previously reported a prospective, randomized trial comparing video-assisted thoracoscopic decortication (VATS) to fibrinolysis for the treatment of empyema. In that study no advantages to VATS were identified, although VAT
article · Oct 2026
Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial
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Purpose: Management of empyema has been debated in the literature for decades. Although both primary video-assisted thoracoscopic surgery (VATS) and tube thoracostomy with pleural instillation of fibrinolytics have been shown to result in e
article · Oct 2026
Panel discussion on fibrinolytic therapy versus VATS for pediatric empyema management
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Dr. Dan Ostlie, Division of Pediatric Surgery, American Family Children's Hospital, presents on empyema. His discussion of patient scenarios generating discussion of topics including empyema initial diagnostic evaluation, treatment, chest t
video31:34 · Oct 2026
CT scans may identify blebs that are incidental findings and not clinically relevant, similar to traumatic pneumatoceles which rarely rupture. — Dan Ostlie, Spontaneous Pneumothorax · 26:41
Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation
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Purpose: Chest tube (CT) management for pediatric primary spontaneous pneumothorax (PSP) is associated with long hospital stays and high recurrence rates. To streamline management, we explored simple aspiration as a test to predict need for
article · Oct 2026
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. Dr. Ostlie is Surgeon-in
podcast33:31 · Jun 2026
Management of spontaneous pneumothorax in pediatric patients
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This podcast is an interactive discussion about the management of spontaneous pneumothorax between Dr. Todd Ponsky and Dr. Dan Ostlie. Dr. Ostlie is Surgeon-in
podcast33:31 · Oct 2026
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Spontaneous Pneumothorax
Primary spontaneous pneumothorax is more common in males by approximately 3 to 1.
epidemiologicalDan Ostlie1:48 ↗
In a multi-institutional retrospective study of 81 patients across 3 institutions over 13 years, no patients with primary spontaneous pneumothorax presented with tension physiology.
clinicalDan Ostlie11:29 ↗
Chest tubes for primary spontaneous pneumothorax work approximately 50% of the time.
clinicalDan Ostlie3:45 ↗
Patients who receive a chest tube, resolve, and go home have approximately a 50% failure rate (recurrence requiring further intervention).
clinicalDan Ostlie5:01 ↗
Patients who fail chest tube management in the hospital and subsequently undergo VATS have a recurrence rate of approximately 25-30%.
clinicalDan Ostlie5:21 ↗
Patients who undergo immediate VATS have a recurrence rate of approximately 10-15%.
clinicalDan Ostlie8:02 ↗
The Society of Thoracic Surgery recommends primary aspiration for spontaneous pneumothorax in adult patients.
Host summaryDan Ostlie summarizing a resource — not the host's own clinical position9:52 ↗
In most large studies of primary spontaneous pneumothorax, the mean age is around 20 to 22 years.
Host summaryDan Ostlie summarizing a resource — not the host's own clinical position10:05 ↗
In the Midwest Consortium prospective study of 33 patients across 9 institutions over 2 years, 50% of patients failed initial aspiration (recurrent pneumothorax within 6 hours).
clinicalDan Ostlie14:10 ↗
Of 12 patients who failed aspiration and were managed with chest tubes, 83% (approximately 10 patients) ultimately failed chest tube management and required VATS or had recurrent pneumothorax.
clinicalDan Ostlie15:33 ↗
Of 5 patients who failed aspiration and went directly to VATS, none had recurrence.
clinicalDan Ostlie16:39 ↗
Of 16 patients who passed the aspiration test and were discharged, 40% (approximately 6-7 patients) returned with recurrent pneumothorax.
clinicalDan Ostlie18:40 ↗
The positive predictive value of aspiration for successful treatment is 83%, with a negative predictive value of 56%.
clinicalDan Ostlie19:07 ↗
A large randomized trial from China of 289 patients (average age 22) showed no difference in recurrence rates between wedge resection alone versus wedge resection with mechanical pleurodesis using standardized sandpaper abrasion of the parietal pleura.
Host summaryDan Ostlie summarizing a resource — not the host's own clinical position23:52 ↗
In the retrospective three-institution study, patients who underwent pleurodesis had the same recurrence rate as those who underwent VATS without pleurodesis.
clinicalDan Ostlie23:30 ↗
CT scans may identify blebs that are incidental findings and not clinically relevant, similar to traumatic pneumatoceles which rarely rupture.
opinionDan Ostlie26:41 ↗
For patients with multiple recurrences after VATS, thoracoscopic pleurectomy (stripping parietal pleura from apex to near-diaphragm) is performed; this is a bloody, painful operation requiring epidural analgesia and hospitalization for a week to 10 days.
clinicalDan Ostlie27:45 ↗
Aerosolized talc pleurodesis is delivered via a canister with a straw inserted through a trocar site, creating a snow-like appearance in the chest.
clinicalTodd Ponsky29:00 ↗
For a patient with a small (2 cm) apical pneumothorax after previous pleurodesis, if asymptomatic and stable on repeat imaging at 48 hours, observation is appropriate; aspiration carries risk of lung injury and worsening the air leak.
opinionDan Ostlie30:15 ↗
Management of spontaneous pneumothorax in pediatric patients
Spontaneous pneumothorax is more common in males by approximately 3 to 1.
epidemiologicalDan Ostlie1:48 ↗
In a multi-institutional retrospective study of 81 patients across 3 institutions over 13 years, no patients presented with tension physiology.
clinicalDan Ostlie11:29 ↗
Chest tube management for spontaneous pneumothorax has approximately 50% failure rate across institutions.
clinicalDan Ostlie3:45 ↗
Patients who receive chest tube, resolve, and go home have approximately 50% recurrence rate requiring subsequent intervention.
clinicalDan Ostlie5:01 ↗
Patients who fail chest tube management in hospital and undergo VATS have 25-30% failure rate.
clinicalDan Ostlie5:29 ↗
Patients who undergo immediate VATS have 10-15% failure rate.
clinicalDan Ostlie8:02 ↗
CT scan data fairly convincingly shows it is probably not beneficial with regard to changing treatment parameters or outcomes in spontaneous pneumothorax.
clinicalDan Ostlie3:05 ↗
The Society of Thoracic Surgery in adult patients recommends primary aspiration for spontaneous pneumothorax.
guidelineDan Ostlie9:54 ↗
In most large studies for primary spontaneous pneumothorax, the mean age is around 20 to 22 years.
epidemiologicalDan Ostlie10:05 ↗
In the Midwest Consortium prospective trial, 33 patients from 9 institutions over 2 years underwent initial aspiration with catheter left in place for 6 hours.
clinicalDan Ostlie15:06 ↗
Of 33 patients who underwent aspiration, 17 (approximately 50%) failed aspiration with recurrent pneumothorax within 6 hours.
clinicalDan Ostlie14:10 ↗
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