Pneumothorax

Pneumothorax (sometimes called a “collapsed lung”) happens when air leaks into the pleural space - the space between the lung and the chest wall - so the lung cannot fully expand. It can range from mild (small air leak with minimal symptoms) to severe, and some forms - like tension pneumothorax - require urgent emergency treatment.
This guide explains symptoms, causes (including spontaneous pneumothorax), possible complications (including recurrence), and how pneumothorax treatment is planned for children.

What Is Pneumothorax?

Pneumothorax occurs when air enters the pleural space either from the outside (for example, after an injury to the chest wall) or from within the lung itself. As air builds up, it creates pressure on the lung and can cause the lung to collapse partially or completely.

Mediastinal Bronchogenic Cyst In A Child

A mediastinal bronchogenic cyst sits in the mediastinum, near important structures such as the trachea, oesophagus, and major blood vessels. In that location, even a benign cyst can cause symptoms earlier because a child’s airway is smaller and more easily compressed.

What Are The Symptoms Of Pneumothorax?

Symptoms can vary depending on how large the pneumothorax is and how quickly it develops. Common symptoms include:

Sudden chest pain (often sharp or stabbing).
Shortness of breath, especially with exertion.
Rapid heart rate (tachycardia).
Bluish lips/skin (cyanosis) in more severe cases.
Anxiety or restlessness.
Decreased or absent breath sounds on the affected side (found on examination).

When to Seek Urgent Medical Care

Seek urgent medical care if a child develops sudden chest pain and shortness of breath. Seek emergency care immediately if breathing difficulty is severe, symptoms worsen rapidly, or the child looks very unwell.

What Causes Pneumothorax In Children?

Pneumothorax can have different causes, and the cause helps guide treatment decisions. Common causes include:

Trauma: Blunt or penetrating chest injuries can puncture the lung and allow air to escape into the pleural space.
Spontaneous pneumothorax: This can occur without an obvious trigger and may be related to rupture of small air-filled sacs (“blebs”) on the lung surface.
Medical procedures: Certain procedures (for example, some biopsies, central line insertions, or mechanical ventilation) can increase pneumothorax risk.
Underlying lung disease: Conditions that weaken or inflame lung tissue may predispose to pneumothorax.

Consequences Of Untreated Bronchogenic Cyst

Pneumothorax can cause significant breathing difficulty, and larger pneumothoraces may require hospital treatment to re-expand the lung. In children and adolescents with spontaneous pneumothorax, recurrence is not rare, with evidence-based reviews reporting recurrence risk in the range of about 21-43%.
From a family perspective, recurrence can mean repeat emergency visits, repeated imaging, missed school or sports, and ongoing worry - so the care plan often focuses on preventing the next episode, not only treating the current one. Recurrent episodes or persistent air leaks are also situations where surgery may be discussed to reduce future recurrence risk.

How To Treat Pneumothorax In Children

Treatment depends on the size of the pneumothorax, symptoms, stability, and whether this is a first episode or recurrence. Options range from observation to chest drainage and, in selected cases, surgery.

Evaluation And Diagnosis

Diagnosis starts with a clinical assessment and imaging, such as a chest X-ray, to confirm the pneumothorax and estimate its size. The most important first step is determining whether the child is stable or needs urgent intervention.

Observation (For Small, Stable Pneumothorax)

Small pneumothoraces with minimal symptoms may resolve without an invasive procedure and can be monitored with repeat chest X-rays. This approach is only appropriate when the child is clinically stable, and follow-up is reliable.

Oxygen Therapy (Supportive Care)

Supplemental oxygen may be used to support oxygenation and relieve symptoms, depending on your child’s condition and the treating team’s assessment. Oxygen is typically supportive, while the overall plan is based on pneumothorax size, symptoms, and stability.

Chest Tube Insertion (When Larger Or Symptomatic)

For larger pneumothoraces or those causing significant symptoms, a chest tube may be inserted into the pleural space to drain air and allow the lung to re-expand. This is often done in a hospital with monitoring to confirm that the air leak resolves and the lung remains expanded.

Surgery (For Recurrence Or Persistent Air Leak)

In cases of recurrent pneumothorax - or when air leakage persists despite drainage - surgery may be recommended to treat the source of the leak and reduce recurrence risk. Surgery is commonly performed using minimally invasive techniques such as VATS (video-assisted thoracoscopic surgery), with the specific approach tailored to your child’s case.

Recovery After Pneumothorax Treatment

Recovery depends on how large the pneumothorax is, whether it is the first episode or a recurrence, and what treatment was needed (observation, chest tube, or VATS surgery). The goals during recovery are to keep your child comfortable, ensure the lung stays fully expanded, and reduce the risk of recurrence.

Recovery After Observation (Small Pneumothorax)

Small pneumothoraces in stable children may be managed with observation and repeat chest imaging to confirm improvement. Parents should return urgently if chest pain or shortness of breath worsens, because symptoms can change if the air leak increases.

Recovery After A Chest Tube

If a chest tube is needed, your child usually stays in the hospital while the tube drains air and the medical team monitors for an ongoing air leak and lung re-expansion. Care commonly includes:

Pain management to keep your child comfortable.
Encouraging deep breathing and gentle movement as advised, to help the lungs re-expand.
Chest X-rays to confirm the lung remains expanded before and after chest tube removal.

After discharge, your child may need a short period of reduced activity, plus follow-up to confirm recovery and discuss how to reduce recurrence risk.

Recovery After VATS Surgery (For Recurrence Or Persistent Air Leak)

When pneumothorax recurs or there is a persistent air leak despite drainage, VATS may be recommended to treat the source of the leak (often blebs) and reduce recurrence risk. After VATS, hospital care often focuses on:

Pain management.
Chest tube monitoring (if used) and removal when the leak settles, and drainage decreases.
Gradual increase in activity and breathing exercises as advised.

At home, recovery continues over the next few weeks, and your surgeon will advise when it is safe to return to full sports and strenuous activity. Follow-up appointments help ensure healing is progressing well and give families a clear plan if symptoms return.

Why Choose The Little Surgery For Pneumothorax Treatment

We provide comprehensive care for children with pneumothorax, including careful assessment, clear counselling for families, and coordination of the most appropriate treatment - whether that is observation, chest tube management, or surgery for recurrent pneumothorax.

Experienced Paediatric Surgeon

Dr Ong Lin Yin has over 20 years of experience in paediatric surgery. Her qualifications include MBBS, MRCS(Ed), MMed (Surgery), and FAMS (Paediatric Surgery). As a Visiting Consultant at the Children’s Surgery Centre at KK Women’s and Children’s Hospital, she continues to be involved in children’s surgical care.

Comprehensive Care

Pneumothorax treatment is not one-size-fits-all - care depends on your child’s symptoms, pneumothorax size, and whether the condition is recurrent. We guide families through the decision-making and explain the role of different treatments (observation, chest drainage, and when surgery is considered), then provide follow-up planning after treatment.

Family Support

We understand that sudden chest pain and breathing difficulty can be frightening, so we focus on clear explanations and practical guidance throughout the treatment journey - from diagnosis through treatment decisions and recovery. Our team will get back to you within 24 hours, and for urgent matters, please call +65 9017 4282.

Contact The Little Surgery Today

If your child has had a pneumothorax (collapsed lung), recurrent episodes, or ongoing chest symptoms, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.