Adenoidal hypertrophy and pulmonary bullae in a child: a case report

This case demonstrates the critical importance of preoperative imaging in pediatric surgery after incidentally detecting a giant pulmonary bulla (3.6 cm) in a Han Chinese child scheduled for routine adenoidectomy. The novelty lies in managing conflicting pathologies-common adenoidal hypertrophy versus rare asymptomatic lung anomalies-requiring multidisciplinary risk-benefit evaluation.

A previously healthy Han Chinese 6-year-old boy was admitted for adenoidectomy using plasma radiofrequency ablation. Preoperative chest radiograph and computed tomography unexpectedly revealed a right lung bulla. Despite meeting surgical criteria for adenoid hypertrophy, the procedure was cancelled owing to anesthesia-related barotrauma risks. A joint decision involving parents, surgeons, and anesthesiologists prioritized conservative management, with nasal steroids for adenoids and monitoring for the bulla.

This case highlights the importance of preoperative thoracic imaging in children undergoing elective surgery, particularly in those of Han Chinese ethnicity, to detect occult anomalies. The incidental finding of a giant pulmonary bulla necessitated a multidisciplinary approach and transparent parent-clinician collaboration, leading to a conservative management strategy. The decision to defer surgery in favor of monitoring underscores the need for individualized risk assessment and patient-centered care in pediatric surgical practice.