Primary Spontaneous Pneumothorax In Children Research Articles

Approach to primary spontaneous pneumothorax: Experiences of a new pediatric surgery clinic

BackgroundThe prevalence of spontaneous pneumothorax in children during adolescence is low, but not negligible. Treatment involves conservative management and surgery. The aim of this study was to review our patients treated with diagnoses of primary spontaneous pneumothorax and to describe our therapeutic approach, outcomes, and deficiencies. MethodsNinety (90) patients diagnosed with primary spontaneous pneumothorax and treated and followed-up in our clinic between June 2020 and December 2023 were included in the study. The research was performed as a retrospective file review. Trauma, secondary pneumothorax, and newborn pneumothorax were excluded. ResultsSeventy six (76) patients were boys and 14 were girls, with a mean age of 16,23 years. Right pneumothorax was present in 44 patients, left pneumothorax in 41, and bilateral pneumothorax in 5. The 90 patients’ initial treatment involved tube thoracostomy, and 36 individuals with prolonged and recurrent pneumothorax underwent video-assisted thoracoscopic surgery (VATS). ConclusionThe success rate of apical wedge resection and mechanical pleurodesis with direct VATS in the treatment of prolonged and recurrent primary spontaneous pneumothorax in children is greater than 90 %. We think that, VATS is a successful, effective and safe treatment for spontaneous pneumothorax due to a significantly lower recurrence rate compared to chest tube insertion.

A retrospective cohort study investigating the etiology of primary spontaneous pneumothorax in children: Radiological and genetic analysis

Background/Aim: Spontaneous pneumothorax is a serious health concern due to its life-threatening nature. It occurs when air sacs in the lungs rupture, causing air to accumulate in the chest cavity and making normal breathing difficult. Primary spontaneous pneumothorax (PSP) refers to the accumulation of air in the pleural space without any traumatic or iatrogenic cause. The objectives of our study are to identify the predisposing factors in PSP patients, determine which patients should undergo genetic analysis, and present the results of a new treatment algorithm. Methods: This study is a retrospective cohort analysis of children diagnosed with PSP and admitted to the emergency department or pediatric surgery clinic. The study evaluates demographic data, radiological findings, and molecular genetic analyses of these patients. Treatment planning was conducted using thoracic computed tomography (CT) or high-resolution computed tomography (HRCT) after the acute phase, and eligible patients were selected for genetic analysis based on syndromes commonly associated with PSP. Results: The study included 14 patients, 10 boys and four girls, with an average age of 16.14 (0.95) years. PSP was detected on the right side in nine male patients and on the left side in one male patient, while in girls, it was detected on the right side in two patients and on the left side in two patients. Radiological findings included air cysts, fibrotic changes, and pleural thickening. Folliculin (FLCN) mutation was detected in two patients after genetic analysis. Conclusion: In the stratified treatment protocol, radiological findings were used as a guide, and the detection of possible syndromic mutations by genetic analysis was deemed important for future management.

Management of primary spontaneous pneumothorax in children: Current practices among Turkish pediatric surgeons.

This study aims to evaluate current practices in the management of primary spontaneous pneumothorax among Turkish pediatric surgeons. Between October 2021 and November 2021, an online survey comprising 19 questions was delivered to all members of the Turkish Association of Pediatric Surgeons (TAPS). A total of 74 respondents (42 males, 32 females; mean age: 42.3±7.9 years; range, 29 to 61 years) were included. The response rate was 17.1% among all society members. The rate of utilization of computed tomography in the initial admission was 27.4%, and the rate of use in cases requiring surgical treatment was 78.4%. A total of 81% of surgeons reported that the size of the pneumothorax influenced management. For the first episode of primary spontaneous pneumothorax, 75.7% of surgeons opted for chest tube drainage, 14.9% for only oxygen administration, 4.1% for needle aspiration, and none of the surgeons preferred video-assisted thoracoscopic surgery. For patients with a persistent air leak after chest tube placement, there was a wide variation in the duration of observation before performing surgery. Video-assisted thoracoscopic surgery was the most preferred surgical intervention (75.3%) and the most preferred surgical method was stapled bullectomy (43.8%). There are practice variations in the management of pediatric primary spontaneous pneumothorax among the society members. However, the majority of members seem to agree on the use of computed tomography, initial treatment, and surgical interventions.

Visible Apical Blebs on CXR: Are Plain Radiographs Under-Utilized in Primary Spontaneous Pneumothorax?

A primary spontaneous pneumothorax (PSP) is caused by rupture of subpleural emphysematous blebs, without inciting event or pre-existing co-morbidity. A previously healthy 16-year-old male presented with upper chest pain. As expected, chest radiographs (CXR) demonstrated a 13mm pneumothorax. Additionally, a 4.7cm apical bleb was identified. After six-hours of observation and non-rebreather oxygen mask therapy, follow-up CXR confirmed stable findings. The patient was subsequently discharged home after symptoms improved. Follow-up CXR at 2-weeks confirmed persistent visible apical bleb. After lengthy discussion addressing patient and parental concerns, elective surgical management was pursued. Current literature suggests blebs are not routinely identified on CXR. While there is no universally accepted management algorithm for PSP in children, visible apical blebs on CXR may influence the decision to pursue surgical intervention. Shared decision making should involve counseling regarding the recurrence risk following surgery, and consideration of patient-specific factors including patient and parental anxiety.

Nationwide Outcomes of Primary Spontaneous Pneumothorax in Children: Fewer Recurrences and Readmissions with Up-Front Operative Resection

INTRODUCTION: Primary spontaneous pneumothorax (PSP) occurs most commonly in adolescent males in the pediatric population. However, considerable variation in PSP management exists. This study aims to compare nationwide treatment and outcomes of children with PSP. METHODS: The Nationwide Readmissions Database (2016 to 2017) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, and elective admissions were excluded. Demographics and complications were compared among patients undergoing initial conservative nonoperative therapy (Non-Op), including observation or percutaneous drainage, or operative resection (OR) using standard statistical tests. RESULTS: A total of 3,980 patients were identified with PSP. Most were adolescent (age 16 [interquartile range 14 to 17] years) males (80%). The majority (78%) underwent Non-Op, of which 30% did not receive drainage, and 17% failed Non-Op requiring OR. Of the intent-to-treat cohort (any initial index Non-Op), 28% failed Non-Op during index admission or required repeat percutaneous drainage or on readmission. Patients treated by Non-Op experienced shorter index length of stay (3 [2 to 6] vs 6 [4 to 10] days) and higher 30-day and overall readmission rates compared with OR (all p < 0.001). Ipsilateral recurrent pneumothorax was higher in those receiving Non-Op (13% vs 3% OR, p < 0.001), and other readmission complications were similar (Table 1). Of those treated by index Non-Op, 5% received OR and 14% received repeat Non-Op during readmission. Table 1. - Readmission Complications and Treatments Among Pediatric Patients with Primary Spontaneous Pneumothorax Readmissions complications and procedures Conservative nonoperative therapy n = 3,120 (78%) Operative resection n = 770 (22%) p Value Postprocedural air leak <1% <1% 1.00 Bleeding <1% <1% 0.095 Effusion 1% 1% 0.321 Ipsilateral pneumothorax 13% 3% <0.001 Contralateral pneumothorax 2% 8% <0.001 Percutaneous drainage 4% 1% <0.001 Operative resection 9% 5% <0.001 Readmission within 30 days 16% 5% <0.001 Readmission within 365 days 29% 15% <0.001 CONCLUSION: In this nationwide cohort, patients with PSP who underwent initial Non-Op therapy experienced significantly higher failure and readmission rates than those receiving OR. This information should be used by surgeons when selecting individual approaches for PSP.

Fifteen-minute consultation: A structured approach to a child with primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) is an uncommon presentation in children but may occur at any age and occurs in patients with no pre-existing lung disease. Management aims are to re-expand...

European Pediatric Surgeons' Association Survey on the Management of Primary Spontaneous Pneumothorax in Children.

To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children. An online survey was distributed to all members of EUPSA. In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery (p < 0.05). Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.

Primary spontaneous pneumothorax in children: A single institutional experience

The treatment of primary spontaneous pneumothorax (PSP) remains controversial. We aimed to examine the role of chest computed tomography (CT), the advantages of pigtail catheter versus chest tube regarding duration of drainage or hospitalization period, and the impact of small PSP and surgical treatment on recurrence rate. We retrospectively reviewed the medical records of 109 children with PSP (20 years' period). Patients with recurrent and those with non-recurrent PSP were compared. We recorded 183 episodes of PSP (45% recurrences), 89 patients (97%) were male, and the median age at presentation was 16 years. There were no significant differences between recurrence and non-recurrence PSP regarding age, gender, medical background, presentation symptoms, type of chest drain, median hospitalization length and median follow-up period. Recurrences were less frequent among patients who presented with small PSP and were treated conservatively (P=0.029). PSP was almost always unilateral and the recurrence was observed ipsilateral in almost 80% of the cases. CT was more frequently used and blebs/bullae were more frequently found among patients with recurrent PSP. Pigtail use had no advantage in reducing hospitalization period and surgical procedures prevented recurrences. The size of pneumothorax at presentation helps to predict recurrences. There are no differences regarding duration of drainage or hospitalization period in the use of pigtail compared to chest tube. CT helps evaluate findings in the lungs in recurrent cases of PSP and surgery prevents recurrences effectively.

Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature.

Introduction: The management of primary spontaneous pneumothorax (PSP) in children still remains controversial. The current literature shows a lack of scientific evidence supporting a standardized management. Materials and Methods: A multicenter retrospective study was performed, patients admitted for PSP in five Pediatric Surgical Units over a 9-year period (from 2008 to 2017) were included. Patient data were reviewed for each case. Management and outcomes were statistically analyzed. Results: Overall 159 patients (135 males and 24 females) were included in this study. During the first hospital admission, 62/159 patients (39%) were conservatively managed with oxygen therapy; 95/159 patients (60%) required a chest drain insertion; 2/159 patients (1%) underwent surgery because of a bilateral pneumothorax. Thoracoscopy was performed in 75/159 (47%) patients after the second hospital admission or for persistent air leak during the first access. Postoperatively, 8/75 (11%) patients developed recurrent pneumothorax requiring chest drain insertion in 3/8 (37%) cases or aspiration in 1/8 (13%), whereas 4/8 (50%) patients were conservatively managed. All of the patients but one, were confirmed to be affected by emphysematous-like changes at histology. Conclusions: Despite the limitations of being a retrospective study, we suggest that the early surgical management in children with PSP is feasible and safe and it seems to significantly reduce the recurrence rate. To the best of our knowledge there are no pediatric guidelines for the management of PSP, therefore, we support the need for prospective studies to create the evidence-based pillars for correct and standardized management of this condition.

Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence.

The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. We reviewed children aged < 18years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4years (14.9-15.9), and body-mass index was 17.9kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.

Management of Spontaneous Pneumothorax in Children: A Systematic Review and Meta-Analysis.

Management of primary spontaneous pneumothorax (PSP) is mainly based on adults. Data are controversial with regards to its management in children. We aimed to assess: (1) the length of hospital stay (LOS) between conservative management (i.e., observation with O2 administration), aspiration/chest drain, and surgical management; (2) the risk of recurrence after nonsurgical treatment versus surgery; (3) the risk of recurrence in the presence of bullae. Using a defined search strategy, three independent investigators identified all the studies on the management of PSP in children. Case reports, opinion articles, and gray literature publications were excluded. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was performed using RevMan 5.3. Data are expressed as mean ± SD. Of 3,089 abstracts screened, 95 full-text were analyzed, 23 were included in the quantitative analysis, and 16 were included in the meta-analysis (1,633 patients). LOS was similar between conservative and surgical management (6.2 ± 0.8 days vs. 5.9 ± 1.4 days; p = ns). Recurrence of PSP was significantly higher among children with a nonsurgical management (32%) versus those surgically treated (18%; p = 0.002). The incidence of recurrence was slightly higher in patients managed by aspiration/chest drain (34%) compared with those with a conservative management (27%; p = 0.05). Risk of recurrence in patients with or without documented bullae was not significantly different (26 vs. 38%, respectively; p = ns). Given the lack of a standardized management of pediatric PSP, the present study seems to demonstrate a better outcome in children treated with surgery as first-line of management. This is a Level III study.

The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children.

Primary spontaneous pneumothorax (PSP) has a high rate of recurrence, and pleurodesis has been shown to decrease the rate of recurrence in adult PSP. For pediatric PSP patients, there are only a few case series available and evidence on the benefits of pleurodesis is insufficient. This study aimed to analyze the outcome of pleurodesis among pediatric PSP patients via a nationwide population-based cohort in Taiwan. The hospitalization data from the pediatric intensive care sampling file of the National Health Insurance Research Database from January 1 to December 31, 2010, were retrieved and analyzed. Children aged 0-18 years with a discharge diagnosis of PSP (ICD-9: 512, 512.0, and 512.8) were enrolled in the study. Demographic data, management strategies, and clinical outcomes were recorded and analyzed as well. A total of 1005 hospitalization cases were identified and divided into the pleurodesis (409 hospitalizations) and nonpleurodesis (596 hospitalizations) groups. In the univariate analysis, thoracoscopic surgery for PSP decreased the incidence of recurrence (hazard ratio [HR], 0.46; 95% CI, 0.32-0.67) and the need for further surgical intervention (HR, 0.29; 95% CI, 0.18-0.47); however, conventional open surgery did not. A lesser incidence of PSP recurrence (HR, 0.53; 95% CI, 0.37-0.78) and fewer subsequent surgical interventions (HR, 0.32; 95% CI, 0.20-0.52) were found in the pleurodesis group in comparison with the nonpleurodesis group. A multivariate Cox regression analysis revealed that pleurodesis was the only significant factor capable of decreasing the incidence of PSP recurrence (HR, 0.57; 95% CI, 0.38-0.86) and the need for further surgical intervention (HR, 0.40; 95% CI, 0.23-0.69). Pleurodesis reduces the rate of recurrence and the need for further surgical intervention in pediatric PSP. It may be considered as the method of choice for the management of PSP in children.

Primary spontaneous pneumothorax in children and adolescents: a systematic review

Primary spontaneous pneumothorax (PSP) is common in young population. But despite its incidence, specific guidelines for pediatric patients are not available and an agreement on the optimal management of this pathology has not been reached yet. Current protocols for treatment of PSP are not up to date at genetic and pathologic advances, remaining those of 20th century. If the presence of blebs and bullae in the apex of the lung is still considered the principal determinant for PSP, the process underlying their formation is not completely clarified. Research on connective tissue pathology and on elastogenesis pathway allowed physicians to identify further predisposing factors for the onset of PSP, for that reason the belief that this disease occurs in “otherwise normal lungs” might be reviewed. For pediatric patients, a more accurate risk stratification of PSP and a specific tailored strategy are required. When inherited or acquired predisposing factors are present, children and adolescents have a higher likelihood to develop PSP than adults, and an early surgical treatment can be proposed. When surgery is needed, mini-invasive approaches are the option of choice. After the advent of videothoracoscopy, surgical techniques have been developed up to a single incision thoracoscopic surgery which allows better outcomes and can be more accepted by younger patients. The aim of this review is to summarize the last thirty years of literature on PSP in young patients, to focus the evidences which can improve the management of this disease.

Primary spontaneous pneumothorax in children: A literature review

Studies about primary spontaneous pneumothorax (PSP) in pediatric patients are not as many as in adult patients since the incidence of PSP is lower in children than in adults. There are evidence-based guidelines for the management of PSP in adults, whereas, in children, the approach of PSP is mainly extrapolated from the adult guideline. In this article, aspects of incidence rate, epidemiology, and pathophysiology, diagnosis, management, and recurrence rate about pediatric PSP are discussed.

Initial primary spontaneous pneumothorax in children and adolescents: Operate or wait?

PurposeThe management of primary spontaneous pneumothorax (PSP) in the pediatric population is not standardized. The purpose of this study was to understand the management options for a first episode of PSP in children and adolescents, and their associated outcomes. MethodsA retrospective study was conducted for patients 5–20 years old with a diagnosis of PSP at a large academic children’s hospital between 2002 and 2014. Patient data were reviewed for each case. Management and outcomes were analyzed and compared between groups. ResultsEighty patients met all inclusion criteria. Overall recurrence rate was 40% with 86% occurring within 12 months of the initial PSP. Patients with recurrent PSP were significantly taller. Size of pneumothorax based on initial chest x-ray was comparable between recurrent and nonrecurrent groups. A negative CT scan for subpleural blebs did not predict recurrence. Patients undergoing thoracoscopic blebectomy and mechanical pleurodesis at initial presentation had significantly lower recurrence rate compared to patients who underwent nonoperative management (operative group 14%, nonoperative group 45%; p=0.0373). ConclusionsRecurrence following nonoperative management was high with the majority occurring within a year and requiring readmission. These findings support offering surgery to families as a potential initial management option. Level of Evidence3b/4 — retrospective series or case control study, single institution, very limited population

Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children

PurposeThere 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. MethodsA 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. ResultsA 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. ConclusionMost 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 studyRetrospective. Level of evidenceIII

Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children

PurposePrimary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. MethodsThe records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. ResultsFifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41–3.92, p<0.01]. ConclusionRecurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. Level of evidenceLevel III, retrospective comparative therapeutic study.

A Clinical Study of Primary Spontaneous Pneumothorax in Children

A Clinical Study of Primary Spontaneous Pneumothorax in Children

Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline.

Primary spontaneous pneumothorax (PSP) is managed in accordance with the adult British Thoracic Society (BTS) guidelines due to lack of paediatric evidence and consensus. We aim to highlight the differences and provide a best practice surgical management strategy for PSP based on experience of two major paediatric surgical centres. Retrospective review of PSP management and outcomes from two UK Tertiary Paediatric hospitals between 2004 and 2015. Fifty children with 55 PSP (5 bilateral) were referred to our Thoracic Surgical Services after initial management: 53% of the needle aspirations failed. Nine children (20%) were associated with visible bullae on the initial chest X-ray. Forty-nine children were assessed with computed tomography scan (CT). Apical emphysematous-like changes (ELC) were identified in 37 children (75%). Ten children had also bullae in the asymptomatic contralateral lungs (20%). In two children (4%), CT demonstrated other lung lesions: a tumour of the left main bronchus in one child; a multi-cystic lesion of the right middle lobe in keeping with a congenital lung malformation in another child. Contralateral asymptomatic ELC were detected in 20% of the children: of those 40% developed pneumothorax within 6 months. Best surgical management was thoracoscopic staple bullectomy and pleurectomy with 11% risk of recurrence. Histology confirmed ELC in 100% of the apical lung wedge resections even in those apexes apparently normal at the time of thoracoscopy. Our experience suggests that adult BTS guidelines are not applicable to children with large PSP. Needle aspiration is ineffective. We advocate early referral to a Paediatric Thoracic Service. We suggest early chest CT scan to identify ELC, for counselling regarding contralateral asymptomatic ELC and to rule out secondary pathological conditions causing pneumothorax. In rare instance if bulla is visible on presenting chest X-ray, thoracoscopy could be offered as primary option.

What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children?

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. 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. 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. 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.