Giant pulmonary bullae in children

Abstract

Background: Bullous lung disease in pediatric patients is a rare entity, and reports of Giant Bullae (GB) in pediatric age group are very few in number. Due to scarcity of these reports, management depends on individual patient presentation. Case presentation: We present two cases with giant pulmonary bullae. The first one is an 11-year-old male child with two weeks history of cough, right sided chest pain and CT scan showed multiple thin-walled air-filled cysts in the same side with mediastinal shift. Bullaectomy was done through a posterolateral thoracotomy. The patient had uneventful intraoperative and postoperative course and discharged improved. He remained stable on subsequent postoperative follow ups. The second patient was 12 years old female who presented with 2 years history of exertional dyspnea with left sided chest pain, cough, loss of appetite and significant weight loss. Chest CT scan revealed left side giant multiseptated bullae with significant mediastinal shift. Bullaectomy was done through a left posterolateral thoracotomy, however the lung remained collapsed despite increased positive pressure ventilation. Patient improved symptomatically, but the lung showed no improvement on subsequent chest x-rays. There was no air leak through the chest tube, which was removed on the seventh postoperative day and patient discharged. Despite marked clinical improvement, the lung remained collapsed on outpatient follow up. Conclusions: These case series represent a rare event in the pediatric population and patients with GB present with compressive symptoms mimicking tension pneumothorax. This series can provide guidance on management of these cases for clinicians.

Keywords

• Giant bullae
• Children
• Pneumothorax
• Thoracotomy
• Bullectomy
• Ethiopia