Pneumothorax secondary to congenital bronchial atresia

We present a rare case of pneumothorax due to the perforation of bullae associated with congenital bronchial atresia. A 25-year-old woman complained of right chest pain and shortness of breath. Chest radiography revealed a right pneumothorax. Chest tube drainage was performed. When the lung re-expanded, chest computed tomography (CT) showed blind-ending B4 of the right middle lobe associated with mucoid impaction and hyperlucency of the corresponding lung parenchyma. Additionally, there were multiple air cysts located at the affected lung surface. A surgical procedure was considered because of persistent air leaks. At operation, several bullae projected above the pleural surface of the hyperinflated S4, and one of the bullae ruptured. A lateral segmentectomy of the middle lobe was successfully performed by thoracoscopy-assisted limited thoracotomy. Diagnosis of congenital bronchial atresia and subpleural bullae was confirmed by pathological examination.