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TENSION PNEUMOTHORAX
Pediatric Respirology Division
Helmi Lubis, dr, SpAK Ridwan M. Daulay, dr, SpAK Wisman Dalimunthe, dr, SpA Rini S. Daulay, dr, M.Ked(Ped), SpA

Pneumothorax
Accumulation of extra pulmonary air within the chest Uncommon during childhood Result from leakage of air from within the lung Air leaks:
Spontaneous Traumatic Iatrogenic Catamenial

Spontaneous Pneumothorax
Primary occurs without trauma or underlying lung disease Secondary complication of underlying lung disorder but without trauma:
Pneumonia Pulmonary abscess Gangrene Infarct Asthma Foreign body in the lung

Traumatic Pneumothorax
External chest / abdominal blunt / penetrating trauma tear a bronchus or abdominal viscus leakage air into pleural space

Iatrogenic Pneumothorax
Complicate of:
Tracheostomy Thoracentesis Transbronchial byopsi Acupunture treatment

Catamenial Pneumothorax
Unusual condition Associated with menses Result from passage of intra abdominal air through diaphragmatic defect

Clinical Manifestations
Pain Dyspnea Cyanosis Involved lung:
Decreased breath sounds Percussion: tympanitic

Larynx, trachea and heart shifted toward unaffected side Gurgling sounds synchronous with respiration open fistula connecting with air containing tissues

Diagnosis
Radiographic examination

Tension Pneumothorax ???

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Evidence of tension:
Shift of mediastinal structure away from the side of air leak Basis of evidence of:
Circulatory compromise Hearing ahiss or rapid exit of the air with the insertion of thoracostomy tube

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Tension Pneuothorax causes:

Limit expansion of contralateral lung May compromise venous return

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Definitive Treatment
Closed thoracotomy:
Drainage trapped air through a catheter External opening in a dependent position under water adequate to re-expand the lung

Open thoracotomy:
Plication of blebs Closure of fistula Stripping of the pleura apical lung

Thoracoscopy

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Chemical pleurodesis:
Talc Tetracycline Silver Nitrate

Pleural pain
Codeine Morphine

analgetic treatment:

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