Background <p>This case demonstrates the critical importance of preoperative imaging in pediatric surgery after incidentally detecting a giant pulmonary bulla (3.6&#xa0;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.</p> Case presentation <p>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.</p> Conclusion <p>This case highlights the importance of preoperative thoracic imaging in children undergoing elective surgery, particularly in those of&#xa0;Han Chinese&#xa0;ethnicity, to detect occult anomalies.&#xa0;The incidental finding of a giant pulmonary bulla necessitated a multidisciplinary approach and transparent parent–clinician collaboration, leading to a conservative management strategy.&#xa0;The decision to defer surgery in favor of monitoring underscores the need for individualized risk assessment and patient-centered care in pediatric surgical practice.</p>