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Conservative Management of Non-Tension Pneumothorax Following Drainage of Pleural Empyema

John Saganty1, Will D Carroll1,2, Francis J Gilchrist1,2

  • 1Department of Paediatric Respiratory Medicine, Staffordshire Children's Hospital at Royal Stoke, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.

Pediatric Pulmonology
|September 9, 2025
PubMed

Insights

Pneumothorax after draining childhood pleural empyema can be managed conservatively. This approach avoids unnecessary surgery for children with stable conditions, leading to complete resolution within months.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Pleural empyema is a serious complication of pneumonia in children.
  • Chest drain insertion for empyema reduces hospital stays but risks pneumothorax.
  • Pneumothorax is often presumed to be under pressure, necessitating surgery.

Purpose of the Study:

  • To report on two pediatric cases of pneumothorax following large empyema drainage.
  • To challenge the assumption that post-empyema pneumothorax requires immediate surgical intervention.
  • To advocate for conservative management of stable, non-tension pneumothorax in children.

Main Methods:

  • Case report of two children treated for pleural empyema.
  • Observation of clinical stability and pneumothorax characteristics post-drainage.
  • Conservative management strategy including monitoring and follow-up.

Main Results:

  • Two children developed pneumothorax after large empyema drainage.
  • Both patients were clinically stable with non-tension pneumothorax.
  • Conservative management resulted in complete resolution in 3-6 months.

Conclusions:

  • Pneumothorax following empyema drainage in children can be managed conservatively if stable.
  • Unnecessary surgical intervention can be avoided by careful assessment.
  • Conservative management offers a viable alternative with favorable outcomes.

Keywords:
chest drainempyemamicrobiologypediatrics

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