PNEUMOTORAX SPONTAN CA MANIFESTARE SEVERĂ A ASTMULUI DIAGNOSTICAT PRIMAR LA COPIL

Abstract

Introducere. Pneumotoraxul spontan reprezintă o complicaţie severa a astmului bronşic necontrolat la copii, apărută frecvent în timpul crizelor severe. Aceasta poate provoca insuficienţă respiratorie acută, necesitând diagnostic şi intervenţie rapidă pentru a preveni complicaţiile severe cu impact pe termen lung. Scop. Prezentarea unui caz clinic a pacientului în varsta de 16 ani, cu astm bronşic diagnosticat primar, care s-a manifestat la debut cu pneumotorax spontan, cu elucidarea factorilor de risc. Material şi metode. Datele clinico-anamnestice, rezultatele investigaţiilor clinice şi paraclinice au fost prelevate din fişa medicală de spitalizare in Institutului Mamei şi Copilului. Diagnosticul a fost confirmat prin investigaţii imagistice, iar evoluţia clinică a fost monitorizată in unitatea de terapie intensivă şi secţia de alergologie. Rezultate. Pacientă în vârstă de 16 ani, a fost internată în stare extrem de gravă cu semne de pneumotorax spontan în unitatea de terapie intensivă. În urma investigaţiilor complexe şi consultaţillor multidisci-plinare a fost stabilit primar diagnosticul de astm bronsic. Din istoricul bolii, s-au constatat mai multe semne clinice tipice pentru astm, care nu au fost appreciate ca exacerbari de astm. La externare a fost indicată terapia de control, care a fost întreruptă neargumentat şi care a avut ca conseciţă acutizarea astmului cu exacerbări severe. La moment pacientul este stabil, primeşte terapie complexă în secţia de alergologie. Concluzii. Cazul prezentat evidenţiază importanţa diagnosticului precoce a astmului la copil cu initie-rea precoce a terapiei antiinflamatorii în scopul prevenirii complicaţiilor severe. Prin acest caz se elucidează eficienţa terapiei de control şi complianţei în relaţie dintre medic si familia pacientului.

Introduction. Spontaneous pneumothorax is a serious and potentially life-threatening complication of poorly controlled bronchial asthma in children, commonly occurring during severe exacerbations. It may lead to acute respiratory failure, requiring prompt diagnosis and intervention to avoid long-term complications. Objective. To present a clinical case of a 16-year-old patient with newly diagnosed bronchial asthma, whose initial manifestation was spontaneous pneumothorax, along with the identification of risk factors. Material and methods. Clinical and anamnesis data, along with results from clinical and paraclinical investigations, were obtained from the hospitalization record at the Mother and Child Institute. The diagnosis was confirmed by imaging investigations, and the clinical course was monitored in the intensive care unit and the allergology department. Results. A 16-year-old female patient was admitted in a critical condition with signs of spontaneous pneumothorax to the intensive care unit. Following complex investigations and multidisciplinary consultations, a primary diagnosis of bronchial asthma was established. From the medical history, several clinical signs typical of asthma were identified, which had not previously been recognized as exacerbations. Upon discharge, controller therapy was prescribed but later unjustifiably discontinued, resulting in severe asthma exacerbations. Currently, the patient is stable and undergoing comprehensive treatment in the allergology department. Conclusion. This case highlights the importance of early asthma diagnosis in children and timely initiation of anti-inflammatory therapy to prevent severe complications. It also underlines the value of controller treatment and the crucial role of communication between doctors and the patient's family.