Lingular collapse with medial pneumothorax: puzzling image in children

Area of Science:

• Pediatric Radiology
• Thoracic Imaging
• Pulmonology

Background:

• Medial pneumothorax can present with atypical radiographic findings.
• A localized density in the hemithorax may obscure the diagnosis.
• Understanding these variations is crucial for accurate interpretation in pediatric patients.

Purpose of the Study:

• To describe the radiographic manifestations of medial pneumothorax in children.
• To identify common associated findings and patient populations.
• To differentiate medial pneumothorax from other thoracic abnormalities.

Main Methods:

• Retrospective review of 20 pediatric cases with medial pneumothorax.
• Analysis of associated radiographic findings, including localized densities.
• Correlation with clinical history, including underlying lung disease, ventilation, and surgical status.

Main Results:

• Medial pneumothorax was associated with superolateral displacement and compression of the lingula, causing a lateral hemithorax density.
• Pulmonary parenchymal abnormalities like hyaline membrane disease or contusion can contribute to the density.
• Commonly observed in newborns (9 cases, 6 on ventilation) and post-cardiac surgery patients (6 cases).
• Other causes included trauma, asthma, and foreign body aspiration.

Conclusions:

• Medial pneumothorax in children frequently presents with a confusing lateral density due to lingular compression.
• This density can mimic pleural fluid or soft tissue masses.
• Recognition of this pattern is important for accurate diagnosis in pediatric chest imaging.