ONE-MONTH-OLD BABY BOY WITH SPONTANEOUS PNEUMOTHORAX
Dian Yosie Monica,Martinus M Leman,Febianto Ary Prihatmono,Monica Joyce Nurina
RS Sentra Medika Cibinong Department of Child Health RS Sentra Medika Cibinong Department of Surgery RS Sentra Medika Cibinong Department of Physical Medicine and Rehabilitation RS Sentra Medika Cibinong
Background : Spontaneous pneumothorax is an abnormal collection of air in the pleural space without any apparent causes, such as traumatic or underlying pulmonary diseases. A complicated spontaneous pneumothorax is progressive air leakage to pleural space that result in lung collapse and displacement of mediastinum. Without proper diagnosis and immediate treatment, it can be life threatening. The annual incidence of spontaneous pneumothorax in the general population is estimated to be 5-10 per 100,000 population, with male predominance, and the peak incidence occurs in person aged 16-24 years or newborns.
Case Presentation Summary : A one-month-old baby brought to ED with chief complaint of sudden onset of shortness of breath began one day before admission. No history of newborn respiratory distress syndrome, recent trauma, or mechanical ventilation. Physical examination revealed lethargic baby with tachypnea, epigastric retraction, and decreased breath sounds over left hemithorax. Chest radiograph showed a left-sided pneumothorax with mediastinal shift to the right. A chest tube connected to Water Seal Drainage (WSD) was immediately placed. Soon after that he became stabilized and could breathe easily. He was admitted to PICU for further intensive observation. There were two times of failures when we tried to release the WSD. A repeated chest radiograph revealed a left hydropneumothorax. He got consulted to Physiatrist to get proper segmental breathing exercises. After 48 hours of adequate chest physiotherapy, the chest tube was successfully removed. The patient had an eventful recovery and discharged after twelve days.
Learning Points/Discussion : The diagnosis is established by high suspicion of respiratory distress with positive physical examination and supported by radiology imaging. Chest tube placement is the most important therapy for large pneumothorax. The segmental breathing exercises provide great help for the lung expansion.