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Pneumothorax (air in the chest) occurs when the lung leaks air out of the air sacs and into the space between the lungs and the bony chest wall. Ordinarily, a very thin film of fluid resides in that space, and the surface tension of the fluid keeps the lungs securely glued to the chest wall and fully expanded. If the surface tension is broken by an air leak into this space, the lungs partially collapse and respiration is compromised.
A pneumothorax may rarely occur in a previously healthy child without warning. This condition generally occurs in the early teens; it is 6 times more likely in boys, but the overall rate for boys is only 7 cases per 100,000 boys. It typically happens in tall, thin boys. Most children with spontaneous pneumothorax have a "bleb" or weak spot in the top portion of one of the lungs, which ruptures either during exercise or stress or perhaps for no particular reason at all.
Chest pain, shoulder pain, and shortness of breath are the most common symptoms. The child may show rapid, shallow breathing, cyanosis or paleness, and rapid heart rate.
Treatment is oxygen therapy, possible chest tube insertion, and ultimately either surgical removal of the bleb or a chemical treatment of the lung surface to prevent further collapse (using "schlerosing agents").
See also pneumothorax for discussion of the condition in newborns.