Images for Surgeons Spontaneous Pneumothorax from Apical Pulmonary Blebs

A 16-year-old male presented to the emergency room with a 6-hour history of pleuritic right chest pain. A chest x-ray revealed a right pneumothorax (A); an unruptured apical bleb was seen on the plain x-ray (arrows). A right chest tube was placed with resolution of the pneumothorax. The next morning, a chest x-ray revealed a left pneumothorax that also required tube thoracostomy. Suction was applied to both chest tubes for 96 hours. Both pneumothoraces recurred after discontinuing suction. The patient underwent bilateral thoracoscopic apical resections. B is an image obtained during inspection of the right chest during thoracoscopy. Multiple peripheral blebs (arrows) are seen on the visceral pleural surface of the lung. The apical chest wall is seen in the background. The patient recovered well with no recurrence of the pneumothorax.