Purpose or Case Report: This study aimed to compare primary (PSP) and secondary spontaneous pneumothorax (SSP) in pediatric patients in terms of clinical,imaging features,treatment and outcome.
Methods & Materials: This single-center retrospective study included patients under the age of 18 with spontaneous pneumothorax, evaluated between January 2015 and January 2025.Clinical data were collected from medical records.Radiologic features assessed included location,bilaterality and pneumothorax size,evaluated using the Collins method on upright chest X-rays (4.2+4.7×[sum of interpleural distances in cm]).Distances were measured from apex to top of the collapsed lung,at mid-lung and at lower-lung distance on the affected hemithorax.Patients were categorized as PSP (occurring in healthy individuals) or SSP (with preexisting lung disorder).Comparisons between groups were performed using Chi-square test for categorical data and Mann–Whitney test for continuous variables.
Results: Seventy-four patients were included, among which 63%(n=47) had PSP and 37%(n=27) had SSP. PSP patients were significantly older than SSP (median 16 years vs 7 years).Males were predominant in both groups:82%(n=38) in PSP and 63%(n=17) in SSP. Thirty-five percent of patients with SSP (n=9) and 15%(n=7) with PSP were admitted to ICU. Patients with SSP had significantly longer hospital stays compared to PSP (median 9.5 days [IQR 18] vs 7 days [IQR 5];p<0.05). Underlying pulmonary diseases in SSP group included infections (n=14), chronic lung diseases (n=5), congenital malformations (n=3) and other causes (n=3). Invasive treatment was required in 50%(n=23) of PSP patients and 66%(n=18) of SSP patients.Larger pneumothoraces were associated with invasive treatment (p<0.05).Collins index was higher in SSP group (median 28 vs 20 in PSP),but the difference was not statistically significant (p=0.27). Recurrence occurred in 21%(n=10) PSP patients and 7%(n=2) of SSP group.Patients with recurrence were significantly older than those without recurrence (median 14 years vs 10 years;p<0.05). Seven percent (n=2) patients have died in the SSP group,while no deaths occurred in the PSP group.
Conclusions: PSP and SSP share similarities regarding gender distribution,pneumothorax size,recurrence rate and in-hospital mortality.In terms of age and hospitalization,SSP patients were younger and had a longer hospital stay.These findings along with the wide variability in patient characteristics, underline the need for individualized diagnostic,management and follow-up strategies.