[Three cases of spontaneous pneumothorax by ruptured paravertebral gourd-shaped bullae].

We reported 3 elderly patients with right pneumothorax caused by ruptured paravertebral gourdshaped bullae. Two patients showed the characteristic symptom of air leakage of this type of pneumothorax, which decreased in the supine position, but increased in the sitting position. Chest computed tomography imaging showed bullae spreading in the space of the azygoesophageal recess. All patients underwent video-assisted thoracic surgery (VATS), and 2 patients underwent mini-thoracotomy because of adhesion and pyothorax. Ruptured bullae with stalks were found at the mediastinal sides of their right lower lobes in all patients. Bullectomy using an endoscopic stapler or ligation at the bulla root was performed easily and safely. The right pneumothorax caused by ruptured paravertebral gourd-shaped bulla was considered to be a good indication for the VATS due to the unique shape of the bulla, which has a stalk at its root.