RETHINKING PRIMARY SPONTANEOUS PNEUMOTHORAX IN CHILDREN AND ADOLESCENTS: CURRENT EVIDENCE AND EVOLVING MANAGEMENT STRATEGIES

Michał Gutowski; Cezary Orzechowski; Monika Kałwak; Sviatlana Filitaryna; Monika Wiatr; Magda Marciniak; Aleksandra Foryś; Justyna Żabicka; Kinga Lichtarska; Patryk Dłubis; Dobrochna Orzechowska

doi:10.31435/ijitss.3(51).2026.6629

Authors

Michał Gutowski Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091, Warsaw, Poland https://orcid.org/0009-0006-7865-8736
Cezary Orzechowski Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091, Warsaw, Poland https://orcid.org/0009-0008-1265-311X
Monika Kałwak Independent Public Healthcare Facility of the Ministry of Internal Affairs and Administration of Sergeant Grzegorz Załoga in Katowice, 39/41 Wita Stwosza Street, 40-042 Katowice, Poland https://orcid.org/0009-0000-4244-3086
Sviatlana Filitaryna Dr. Tytus Chałubiński Specialist Hospital in Radom, 4 Lekarska Street, 26-610 Radom, Poland https://orcid.org/0009-0003-8897-0254
Monika Wiatr Dr. Tytus Chałubiński Specialist Hospital in Radom, 4 Lekarska Street, 26-610 Radom, Poland https://orcid.org/0009-0000-2038-3174
Magda Marciniak Dr. Tytus Chałubiński Specialist Hospital in Radom, 4 Lekarska Street, 26-610 Radom, Poland https://orcid.org/0009-0005-4016-6536
Aleksandra Foryś Provincial Specialist Hospital No. 5 of St. Barbara in Sosnowiec, 1, Medyków Square, 41-214 Sosnowiec, Poland https://orcid.org/0009-0008-7983-1443
Justyna Żabicka Maria Skłodowska-Curie Medical Academy in Warsaw, 12 „Solidarności” Avenue, 03-411 Warsaw, Poland https://orcid.org/0009-0002-0612-0938
Kinga Lichtarska St. Elizabeth’s Hospital, LUX MED Group, 1 Goszczyńskiego Street, 02-616 Warsaw, Poland https://orcid.org/0009-0004-9319-8323
Patryk Dłubis Municipal Hospital in Gliwice LLC, 20 Zygmunta Starego Street, 44-100 Gliwice, Poland https://orcid.org/0009-0009-2952-6675
Dobrochna Orzechowska Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091, Warsaw, Poland https://orcid.org/0009-0004-7178-4102

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6629

Keywords:

Primary Spontaneous Pneumothorax; Pediatric; Adolescent; Video-Assisted Thoracoscopic Surgery; Computed Tomography

Abstract

Primary spontaneous pneumothorax (PSP) is increasingly identified in adolescents, but its management is still debated due to a lack of robust pediatric data and a reliance on adult guidelines. As a result, pediatric centers show significant differences in their approaches to diagnosis, imaging, treatment decisions, surgical timing, and follow-up care.

This review outlines the latest evidence on diagnosing and managing pediatric primary spontaneous pneumothorax (PSP). Current research favors a symptom-based diagnostic method, with chest X-rays serving as the primary imaging tool. Routine CT scans are discouraged because they expose children to unnecessary radiation, rarely change initial treatment plans, and fail to reliably predict recurrence based on radiographic blebs. Ultimately, treatment strategies should be customized based on the patient's clinical stability rather than relying solely on the size of the pneumothorax. Observation is a suitable approach for certain stable patients with small to moderate PSP. Conversely, treatments such as needle aspiration, chest tube drainage, or surgery should be utilized only for patients experiencing severe symptoms, continuous air leaks, unsuccessful lung re-expansion, or recurring pneumothorax. When surgical intervention is required, video-assisted thoracoscopic surgery is the favored method, though post-operative recurrence rates are higher in children compared to adults.

Current evidence indicates a lack of standardized follow-up procedures for pediatric patients. Therefore, follow-up care should center on the early detection of recurrences, which typically happen within the first year of the initial event. The use of routine computed tomography for follow-up is not recommended. Additionally, patient counseling needs to address smoking and vaping cessation, guidelines for resuming physical activity, postponing air travel until imaging shows complete healing, and avoiding compressed-air diving due to a lifelong recurrence risk.

Although recent progress has been made, significant knowledge gaps persist concerning the ideal selection of patients for conservative rather than surgical treatment, risk factors for recurrence, uniform follow-up protocols, and long-term results. To develop evidence-based, child-specific guidelines for diagnosing and treating primary spontaneous pneumothorax, future prospective multicenter pediatric studies are essential.

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