CRP14 THE BUBBLE IN THE LUNG: PAEDIATRIC LUNG BULLAE AND WHAT’S BEST FOR CARE

W.KENT LEE1, KANDIAH V1, DAMIA ISMAIL1, A.FADZIL2
1Hospital Tengku Ampuan Afzan, Kuantan, Malaysia
2International Islamic University Malaysia (IIUM), Kuantan, Malaysia

Introduction
We report a case of a 10-years-old normal built boy with no marfanoid features who presented with a spontaneous right-sided pneumothorax and developed symptoms of chest pain and dyspnoea. He was managed conservatively until Day 7 of admission required needle thoracocentesis due to unresolved pneumothorax and discharged well two days later. A month later, CECT thorax revealed a right apical subpleural bullae. There was no surgical intervention planned as he was asymptomatic. However, he was counselled for risk of recurrent pneumothorax and potential of surgeries in future. Serial Chest X-Ray revealed spontaneous resolved lung bullae and he remained asymptomatic.

Objectives
To establish a stepwise approach and management of primary spontaneous pneumothorax with lung bullae in children and explore risk stratification tools.

Methodology
A systematic review of current practice used worldwide in children.

Results 
Clinically stable and asymptomatic patients with small pneumothorax (<20% by Light Index) are suitable candidates for conservative management including oxygen therapy and observation. Surgical intervention is indicated in cases of recurrence, persistent air leaks, or failure of lung re-expansion. The presence of blebs or bullae on CT significantly increases the risk of recurrence (48%) compared to those without (20%). When surgery is warranted, Video-Assisted Thoracoscopic Surgery (VATS) with bullectomy and pleurodesis is preferred for its low morbidity, improved pain control, shorter hospital stay, and reduced recurrence rates.

Conclusions
This case highlights the importance of individualized management and multidisciplinary approach. Non-operative options such as needle aspiration, outpatient pigtail catheters and tube thoracostomy are valuable in selected cases. Early surgical consultation and education on recurrence risks is crucial for long-term care planning in children with lung bullae.