GIANT PULMONARY BULLA MIMICKING PNEUMOTHORAX IN CHILDREN. DIAGNOSTIC AND MORPHOPATHOLOGICAL CONSIDERATIONS

Introduction. Giant lung blistering in children is rare. In this context, the authors present a clinical case, which demonstrates the diagnostic difficulties, the way of surgical treatment and the morphopathological aspects of this nosological entity. Case report. A 12-year-old male patient with asthenia, weakness on exertion and dyspnea for 8 months was hospitalized for spontaneous right pneumothorax, the diagnosis being established by chest radiography and confirmed by computed tomography. At the same time, the patient was suffering from thymomegaly with congenital primary hypothyroidism, because of which gets treatment with L-thyroxin, and cystic formation of the thyroid gland undergoing surgical treatment. The patient underwent video-assisted thoracic surgery (VATS), and a giant bladder located in the upper lobe of the right lung was identified intraoperative, which was excised by right latero-posterior micro thoracotomy. The postoperative evolution was without particularities, radiologically being found the gradual re-expansion of the upper lobe of the right lung, in which the pulmonary scintigraphy revealed insignificant changes of pulmonary perfusion. Conclusions. 1. The differential diagnosis between giant lung blister and pneumothorax is quite difficult, being essential in assessing treatment tactics. 2. Bulectomy with suturing and adequate aerostasis of the resection line at the level of healthy lung tissue is a safe and feasible technical procedure in resolving this pathology. 3. The carried out histological investigations, in this case, established some morphopathological features of the structural components, which are characteristic of a cystic formation of bronchial origin, which contained elements of residual muscle tissue, nerve bundles, sclerogenized-obliterated arteries and lymphocyte component. Pseudo-follicular, the changes found questioning the dysontogenetic origin of the giant lung bubble in children