Successful Management of a Large Pediatric Traumatic Pneumothorax Using a Thoracic Vent Device After Blunt Chest Injury: A Case Report.

Traumatic pneumothorax is a common complication of blunt thoracic trauma and is traditionally managed with tube thoracostomy, particularly in larger or symptomatic cases requiring pleural decompression. Thoracic vent devices, such as the UreSil Thora-Vent, represent a less invasive pleural drainage option for the management of spontaneous or iatrogenic pneumothorax. However, literature regarding their use in traumatic pneumothorax, particularly in pediatric patients, remains limited. We present a case of a 13-year-old girl who developed a large left-sided traumatic pneumothorax after blunt thoracic trauma sustained during a softball collision. Computed tomography demonstrated a large left-sided pneumothorax and a nondisplaced left sixth rib fracture. Despite the extent of injury, the patient remained hemodynamically stable and maintained adequate oxygenation on room air. A thoracic vent device was placed in the emergency department under ketamine sedation, resulting in immediate air return and near-complete radiographic lung re-expansion. During hospitalization, the thoracic vent device was initially managed on water seal, and serial imaging demonstrated improvement in lung re-expansion. However, subsequent imaging revealed a transient interval increase in pneumothorax size, prompting transition to continuous suction. Despite these fluctuating radiographic findings, the patient remained clinically stable without worsening respiratory distress or need for supplemental oxygen. The thoracic vent device was removed on hospital day 3, and the patient was discharged in stable condition on hospital day 4. Follow-up chest radiography one week later demonstrated complete resolution of the pneumothorax. This case demonstrates the feasibility of thoracic vent use as a less invasive management strategy in carefully selected, hemodynamically stable pediatric patients with trauma. It also highlights the importance of close serial imaging, ongoing clinical reassessment, and a clearly defined escalation strategy when employing less invasive pleural drainage approaches in pediatric traumatic pneumothorax management.