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

Pediatr Radiol. 2007 Sep;37(9):879-84. doi: 10.1007/s00247-007-0537-7. Epub 2007 Jul 14.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Blister / complications*
  • Blister / diagnostic imaging*
  • Female
  • Humans
  • Male
  • Observer Variation
  • Pneumothorax / complications
  • Pneumothorax / diagnostic imaging*
  • Reference Values
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*