Primary spont PTX paeds

Question 1

key points in mng of primary spont PTX in children

Answer 1

Size less important than degree of clinical compromise
Severe clin f od resp distress suggest tension PTX

Question 2

def primary spont PTX

Answer 2

without underlying lung disease and in the absence of provoking factors such as trauma, surgery or mechanical ventilation

Question 3

Recurrence rate of spont PTX in children

Answer 3

30-40%, typically on same side and within 1 year

Question 4

clin f of primary spont PTX

Answer 4

Acute onset chest pain: severe and/or stabbing pain, radiating to ipsilateral shoulder and increasing with inspiration (pleuritic), can subside over 24 hours despite a persistent pneumothorax
Sudden shortness of breath
Anxiety, cough and generalised symptoms (eg malaise, fatigue) are less common

Question 5

examination findings primary spont PTX

Answer 5

Children with a small pneumothorax may have a normal examination
Tachycardia and tachypnoea
Hyperresonance on percussion
Ipsilateral decreased or absent air entry and decreased vocal fremitus
Asymmetric lung expansion
Mediastinal shift
Consider transillumination in young infants
Tension Pneumothorax
Deviation of the trachea to the contralateral side
Tachycardia
Hypotension
Cyanosis

Question 6

CXR finsings of PTX

Answer 6

A linear shadow of visceral pleura with lack of lung markings peripheral to it indicates collapsed lung
Flattening or inversion of the diaphragm on the affected side
Mediastinal shift toward the contralateral side
Small pleural effusions are commonly present
If CXR is taken in supine position, signs of pneumothorax include:
Deep sulcus sign, lucency along the costophrenic angle is abnormally deepened
Hyperlucency of the affected side

Question 7

Def of large PTX in children >12yo

Answer 7

Measurement of the vertical distance between the lung and thoracic cage at the apex (a). If >3 cm, pneumothorax is large
OR
Measurement of the distance between the lateral lung edge and chest wall at the level of the hilum (b); >2 cm = (at least 50%)

Question 8

mng flowchart of primary spont PTX in children

Answer 8

https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/Community_acquired_pneumonia_diagram(1).png