CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls

Abstract

Background

Spontaneous pneumothorax (SPTX) is a relatively common condition. In patients with SPTX, CT has been advocated to identify blebs and bullae (BB) to help in management planning.

Purpose

The study was designed to assess our experience with CT evaluation for underlying BB in children with SPTX as compared to normal controls.

Materials and methods

Forty-three children (mean age 16 years, range 13–19 years) with 50 SPTX events with both chest radiographs and CT scans were reviewed. CT findings were compared with those seen in 29 age- and gender-matched controls without SPTX. The parameters evaluated included size, number, location, and ipsi-/contralateral BB; apical lines; and surgical correlation.

Results

In the study group, BB were identified in 14 imaged events (28%) (size 2.5–45 mm, one to six BB) with contralateral BB in 11 of the 14 (78.6%). All BB were confined to the apices. BB were sometimes difficult to differentiate from “apical lines”—a suspected normal variant seen in 28 imaged events (56%). Of blebs seen at surgery, 59% were identified on CT, and there were no false-positive CT findings. In the control group, no BB were identified but “apical lines” were seen in eight children (28%).

Conclusion

BB were seen by CT in 28% of imaged events in children with SPTX and were always confined to the apices. When present, BB were commonly bilateral (78.6%). BB should not be confused with “apical lines,” which were not only seen in 56% of imaged events in the SPTX group but also in 28% of the normal controls.