PRIMARY SPONTANEOUS PNEUMOTHORAX IN CHILDREN

In the absence of pediatric data, spontaneous pneumothorax is managed according to adult guidelines. Fifty-eight patients with primary spont aneous pneumothorax (PSP) were treated in our center over the last 20 years. The median age was 16.7 years, and the male:female ratio was 1. 9:1. A total of 102 PSP were treated; 63% were left-sided. The risk of recurrence was 51% after one PSP and 56% after two. There were four m etachronous bilateral PSP. Nonoperative management included tube drain age in 57% of the cases (mean extent of PSP, 53%). Forty percent of pa tients were treated by supplemental oxygen and observation, without dr ainage (mean extent of PSP, 23%). Eleven patients were treated as outp atients, with Heimlich valves (mean extent of PSP, 64%). Fourteen pati ents (28%) underwent bullectomy, with or without pleurodesis. Thirteen of the surgically treated patient had experienced at least two episod es of PSP. Primary spontaneous pneumothorax in children has male predo minance. The risk of recurrence after one episode is greater than that for adults. Operative management by bullectomy, with or without pleur odesis, carries little morbidity, has a high success rate, and is reco mmended after the first recurrence. It is safe to manage younger child ren conservatively because the chance of recurrence is lower; thora co tomy was not necessary in children under 9 years of age. Copyright (C) 1994 by W.B. Saunders Company