Treatment of primary spontaneous pneumothorax in pediatric patients: 15-year experience at a single-institution

Background: Primary spontaneous pneumothorax (PSP) is a relatively uncommon condition in children. Due to the lack of pediatric-specific guidelines the treatment strategy varies among different centers. This study demonstrates a single-institution experience in the treatment of primary spontaneous pneumothorax in pediatric patients. Materials and methods: Retrospective review of 49 patients with the diagnosis of primary spontaneous pneumothorax between 2003 and 2018 who were treated conservatively or invasively at the surgical department of Children’s Hospital Zagreb. Results: During the period of 15 years there were 49 patients noted with spontaneous pneumothorax at the surgical department of Children’s Hospital Zagreb. The patient age ranged from 11 to 18 years (mean 15.28). 36 patients were male and 13 female, with a male to female ratio of 2.77:1. Pneumothorax occurred on the left side in 31 patients, on the right side in 15 patients, and on both sides in 3 patients. Clinical presentation in all patients was sudden, powerful chest pain. Other symptoms include dyspnea, cough. In all patients, a plain x-ray was made, and later the vast majority of patients underwent computed tomography (CT) scan. The CT scans detected 13 cases of apical bullae, 2 large bullae, 1 bulla in 6. segment and 1 parenchymal inflammation. Eight patients with stable clinical presentation and small pneumothorax underwent hospital observation. Eighteen patients were successfully managed with chest tube drainage without recurrence. Video-assisted thoracoscopic surgery (VATS) was performed on 19 patients with only two recurrences. Open thoracotomy was performed on 4 patients. Conclusion: Due to the variation of diagnostic and therapeutic approaches from different centers, the creation of guidelines and standardized practice for the pediatric patient is necessary