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• Spontaneous Pneumothorax – larger than you think!
  Anjum Gandhi
  Published on: 3 May 2006

• Published on: 3 May 2006

  Spontaneous Pneumothorax – larger than you think!

  • Anjum Gandhi, Locum Consultant Paediatrician

  Dear Editor,

  Drs Thakur and Pocha present an interesting case of spontaneous primary pneumothorax. It is not unusual for such cases to present late. In fact in nearly half the cases medical opinion is sought after 2 days or more. The uncertainty about the management of primary and secondary pneumothoraces appears to have been resolved by the revised guidelines published by the British Thoracic Society (BTS) in 2003....

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  Dear Editor,

  Drs Thakur and Pocha present an interesting case of spontaneous primary pneumothorax. It is not unusual for such cases to present late. In fact in nearly half the cases medical opinion is sought after 2 days or more. The uncertainty about the management of primary and secondary pneumothoraces appears to have been resolved by the revised guidelines published by the British Thoracic Society (BTS) in 2003.

  This case provides the right opportunity to highlight certain key issues. Firstly pneumothoraces appear deceptively small on a 2-dimensional AP chest radiograph. A pneumothorax measuring 2 cm on a chest x-ray where the hemi thoracic diameter is 10 cm represents a loss of nearly 50% of the lung volume. This is much larger than what x-ray appearance might suggest. The new BTS guidelines have emphasized this by classifying pneumothoraces into two groups, large (>/= 2 cm) and small (< 2 cm). The x-ray shown suggests that the case presented perhaps had a large pneumothorax by definition. The recommended management of such a patient as per the BTS algorithm would probably be needle aspiration rather than simple observation.

  Secondly it is important to remember that in general the resolution of spontaneous pneumothoraces is a slow process occurring at a rate of 1.25% to 1.8% of the hemithorax volume per day. A 50% pneumothorax would therefore take approximately 4 weeks to resolve. Consequently frequent x- rays are unwarranted. The process of resolution can be speeded up to four times by the use of supplemental high flow (10 litres/minute) oxygen, and this should be offered to any patient who is observed in the hospital.

  Spontaneous pneumothorax is not an every day problem encountered by paediatricians. The new BTS guidelines are a great asset in tackling this problem.

  Reference:

  1. Henry M, Arnold T, Harvey J. BTS guidelines for management of spontaneous pneumothorax. Thorax 2003;58:ii39.

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  Conflict of Interest:
  None declared.

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