Aim

Management of teenagers with primary spontaneous pneumothorax (PSP) is not consensual. We report our experience over an 11-year period.

Methods

For each patient under 20 years hospitalized with PSP from 2008 to 2018, demographic data, smoking habits, clinical presentation, hospitalization unit, radiological management and its results, therapeutic management (observation, needle aspiration, chest tube drainage, surgery), complications, length of stay, given advices at discharge, and recurrence were collected.

Results

Seventy patients were included in different pediatric or adult surgery or pulmonology wards (82.9% boys; 16.8±1.7 years; 1 severe presentation; 18/58 smokers). Chest CT-scan (n=42/70, 60%) revealed blebs/bullae in 18/39 exams (46.2%). Treatment consisted of observation (14/70, 20%), needle aspiration (2/70, 2.9%), chest tube (53/70, 75.7%), and video-assisted thoracoscopy surgery (27/70, 38.6%). Half patients with interventional procedure presented complications. A median of 10 chest X-rays was noted during a median stay of 8 days. Advices concerning sport practice, flying, smoking, etc., were variably delivered. PSP recurrence concerned 35/70 patients (50%) without identified predictive factors.

Conclusion

Compared to recent recommendations of a more conservative approach, chest CT-scan and interventional strategy are overused in our teenagers with PSP. Observation, more or less needle aspiration, should be clearly the first-line treatments.