Recurrent Spontaneous Pneumothorax in Young Male with Apical Giant Bulla: Video-assisted Thoracoscopic Surgery-guided Interventions are Gold Standard Approach!

Abstract Recurrent pneumothorax refers to the repeated occurrence of air leakage into the pleural space, leading to lung collapse. It can be spontaneous (primary or secondary) or result from trauma or medical procedures. The causes include underlying lung diseases such as chronic obstructive pulmonary disease, cystic fibrosis, connective tissue disorders, and smoking. Recurrent spontaneous pneumothorax (RSP) is a challenging clinical entity, particularly in young, otherwise healthy individuals. It is frequently associated with the presence of apical blebs or bullae, which predispose patients to the repeated episodes of lung collapse. We report the case of a 26-year-old male who presented with recurrent episodes of right-sided spontaneous pneumothorax over a span of 12 months. Initial conservative management with intercostal tube drainage provided temporary relief, but recurrence necessitated further intervention. High-resolution computed tomography of the chest revealed multiple small apical giant bulla in the right lung. Given the high risk of future recurrence, a decision was made to proceed with thoracoscopic intervention. The patient underwent video-assisted thoracoscopic surgery (VATS) with bullectomy and mechanical pleurodesis. Intraoperatively, multiple apical bulla were identified and resected. Mechanical pleurodesis was performed to enhance pleural adhesion and reduce the likelihood of further pneumothorax episodes. In conclusion, RSP in young individuals with apical bulla should prompt the early consideration of thoracoscopic interventions. VATS bullectomy combined with pleurodesis provides a durable solution, significantly reducing recurrence rates and improving patient outcomes.