THE ETIOLOGY AND THERAPEUTIC MANAGEMENT OF PNEUMOTHORAX AND PNEUMOMEDIASTINUM IN CHILDREN

Introduction. Pneumothorax, pyopneumothorax and pneumomediastinum are rare but severe entities in pediatric respiratory pathology. They are often associated with severe pulmonary infections with multidrugresistant germs and are a major cause of morbidity in children, most of the time being medical emergencies. Material and method. The objective of the study was to analyze retrospectively for a period of 4 years the etiology, the treatment and the clinical and laboratory data of a group of 48 children admitted and treated in SCUC Grigore Alexandrescu Hospital, Bucharest with diagnosis of pneumothorax, pyopneumotorax or pneumomediastinum. Patients with traumatic pneumothorax were excluded. Results. The main etiology was pneumonia followed by primary spontaneous pneumothorax, congenital malformations (especially digestive tract), and asthma. The pneumonia frequency was 42.48%, and Streptococcus pneumoniae was the most frequent etiologic agent The group also included 2 cases of pleuropulmonary tuberculosis and one case with hydatid cyst, Marfan syndrome, cystic fibrosis, foreign body aspiration, lymphoma and pneumonia with Pneumocystis jirovecii. Dyspnea and chest pain dominated the clinical picture. The therapeutic conduct was dictated by the etiology. It included simple oxygen therapy in small pneumothoraces, pleural drainage in the massive ones and pleural drainage and broad spectrum antibiotic therapy in the case of pyopneumothorax. It was considered necessary to establish pleural drainage in 64.29% of children, 52% of those with pneumothorax, and all patients with pyopneumothorax. The duration of pleural drainage ranged from one day to 35 days for the pneumothorax, with a median of 6 days, respectively between one day and 32 days, with a median of 19 days for the pyopneumothorax. The average patient hospitalization was 16 days. Conclusions. Pneumothorax is rare in daily clinical practice, but can be a major pediatric emergency. Treatment aims to ensure full lung expansion and prevent relapses. Management is different depending on etiology and severity. Oxygen therapy is very important, and it increases the rate of reabsorption four times. Prognosis is often good for patients without sequelae, in primary spontaneous pneumothorax, recurrences are frequent.