A number of processes may result in pulmonary tension phenomena or tension pneumothorax in the neonatal period and in infancy. Localized hypertrophic emphysema, progressive infantile emphysema, obstructive lobar emphysema, and congenital pulmonary cysts are some of the diagnostic terms encompassing essentially indistinguishable clinical and roentgenographic entities. Hypoplasia of the lung with compensatory emphysema in adjoining pulmonary tissue may also be postulated in such instances. Congenital diaphragmatic hernia, with loops of gas-filled bowel protruding into the chest, may be confused clinically and on x-ray films with tension pulmonary cysts or bullous emphysema.
Although the primary lesions may vary, the assorted processes producing tension dynamics in the lung or pleural space of the infant result in clinical pictures sufficiently similar to warrant their collective consideration. Our experience with five consecutive patients, of ages 6 days to 4 months, in extremis from progressive tension states illustrates this surgical indication.
Report of Cases
GILBERT JW, MYERS RT. Intrathoracic Tension Phenomena in the Neonatal Period and Infancy. AMA Arch Surg. 1958;76(3):402-406. doi:10.1001/archsurg.1958.01280210072014