Sixteen consecutive children diagnosed with spontaneous pneumothorax (SP) and admitted to Chang Gung Children's Hospital between July 1994 and June 1999 were retrospectively studied. The presenting features, radiographic abnormalities, and indications of surgery were reviewed. All patients were exclusively adolescents and were aged between 12 and 17 years. Six patients received chest tube drainage only. Nine patients underwent ablation of blebs or bullae using video-assisted thoracoscopic surgery (VATS) with good results. One patient had a bullous emphysema removed by wedge resection. One patient with spontaneous hemopneumothorax required a blood transfusion and emergent thoracotomy for stabilization. Computed tomographic (CT) scans of the chest detected all seven (100%) cases with apical bulla formations. First episodes of spontaneous pneumothorax were treated conservatively using closed-tube thoracostomy if the plain chest radiographs and CT scans were negative for apical bleb or bulla formations. In summary, SP occurred exclusively in adolescents in this study, commonly they had no underlying pulmonary abnormalities except for bulla or bleb formations. SP can be safely and effectively managed using VATS and abrasive pleurodesis in children without recurrence at follow-up. SP may be treated surgically even in the first event of pneumothorax when subpleural blebs are demonstrated by high-resolution computed tomographic scans.
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