Case

report: Recurrent pneumothorax Sri Lanka Journal of Critical Care

Case Report (PROVISIONAL PDF)

Recurrent spontaneous pneumothorax in a child

Ramdas D Nagargoje, Pradnya S. Bendre, Madhavi V.Thakur.
Department of Paediatric Surgery, BJ Wadia Hospital for Children, Parel, Mumbai, India


Abstract
A 3 year old female child presented with three episodes of left sided pneumothorax in last four
months. Patient has minimal respiratory distress in each admission with low grade fever in first
two admissions. Intercostal drain was put in first two episodes and VATS with thoracoscopic lung
biopsy was done in third episode from left upper lobe with no further episodes of pneumothorax.

Introduction point she had no respiratory distress and
Primary spontaneous recurrent was otherwise asymptomatic. In view of
pneumothorax is rare in children, with male this, intercostal drainage was not
&left sided preponderance. Operative performed. CT thorax showed
management by bullectomy with or without pneumothorax and collapse of the left lung,
plurodesis carries little morbidity, has a with multiple thin strands in the upper lobe
high success rate and is recommended after with a few cystic areas suggestive of
first recurrence. multiple blebs/bullae, with a few sub-
centimeter lymph nodes. Bronchoscopy
Case Report was performed and was normal.
A 3-year-old female child was admitted With a differential diagnosis of
with respiratory distress and fever, and Staphylococcal pneumonia and
history of recurrent cough. She was born histiocytosis in mind, video assisted
full term, normal delivery of non- thoracic surgery (VATS) and lung and
consanguineous parents, and had been fully pleural biopsy was undertaken. There was
immunized. Chest radiograph showed left- evidence of a few blebs in left upper lung
sided large pneumothorax with mediastinal fields but no grossly enlarged bullae. The
shift to right side. An intercostals drain was rest of the thoracic cavity on the left side
inserted; she patient had an uneventful was grossly normal. Lung biopsy taken from
recovery and was discharged after seven an area having blebs showed changes
days. consistent with recurrent pneumothoraces.
Seven weeks later, the patient again Pleural biopsy histology showed
developed respiratory distress of lower Langerhans giant cells with histiocytes on
severity, and low grade fever. Chest pleural biopsy.
radiograph showed left sided Immunohistochemistry excluded
pneumothorax. An intercostal drain was langerhans cell histiocytosis &other
inserted once more. Routine investigations neoplastic conditions [immunonegative for
have shown elevated total leukocyte count. s100, CD1a and desmin].
Investigations for tuberculosis were The patient was started put on
negative. CT thorax was performed, and intravenous antibiotics for seven days and
confirmed a large pneumothorax on the left then discharged on oral medications. There
side with collapse of lung. Patient was have been no recurrences for six months
discharged after complete resolution of after this episode.
pneumothorax. The clinical diagnosis at this
point was staphylococcal pneumonia with Correspondence to: Dr Pradnya S. Bendre, Head of
bleb formation. Department, Department of Paediatric Surgery,
One month later, at a follow up visit, the BJ Wadia Hospital for Children, Parel, Mumbai,
patients chest radiograph, at routine follow India. Email: psbendreunit@gmail.com
up, showed left large pneumothorax. At this

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Case report: Recurrent pneumothorax Sri Lanka Journal of Critical Care

Figure 2:

Figure 1

Figure 3
It is uncommon for recurrent
Discussion pneumothorax to occur in children.
Prompt diagnosis and timely Accurate diagnosis and management of
intervention is very necessary in patients recurrent pneumothorax is challenging. The
with pneumothorax. The most common largest case series of recurrent
mode of presentation is with respiratory pneumothorax reported so far is of 57
distress associated with fever and cough. cases. Recurrent pneumothorax in children
These patients need urgent admission and has a male predominance [1.9:1] with left
management in the form of broad spectrum sided involvement slightly more common
antibiotics, anti-tuberculosis treatment if (63%) than on the right side.
indicated, and intercostal drain insertion. Risk of recurrence is 51% after one
episode & 56% after second episode. Risk of

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Case report: Recurrent pneumothorax Sri Lanka Journal of Critical Care

recurrence is greater in children than in 5. Bullectomy with or without

adults. In children bacterial infections most pleurodesis
commonly staphylococcal, associated with
formation of large bullae with rupture in the Conclusion
pleural space is the most common cause for Recurrent primary spontaneous
recurrent pneumothorax. Patients generally pneumothorax is rare in children, with male
present with respiratory distress, with fever and left sided preponderance. Operative
and cough. management by bullectomy with or without
Treatment modalities are in the form of plurodesis carries little morbidity, has a
high success rate and is recommended after
1. Non operative oxygen first recurrence
supplementation, HPD &
observation Acknowledgements: None
2. Tube drainage Sources of funding: None
3. Pleurodesis Conflict of interest: The authors declare no
4. Heimlich valves conflict of interest.



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