Bronchoscopic lung volume reduction using an endobronchial valve to treat a huge emphysematous bullae: a case report

Abstract

Background In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume reduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise tolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an endobronchial valve has not been attempted in patients with giant bullae. Case presentation We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous emphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large bullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually worsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to treat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA) confirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial valve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patient’s symptoms and quality of life improved markedly. Conclusion This case supports recent suggestions that BLVR can serve as a good alternative treatment for appropriately selected patients.

<p>Chartis System Corrected a Misjudged Location of a Giant Bulla Facilitating a Successful Bronchoscopic Bullectomy with Valves: A Case Report</p>

“…6,7 There are several papers including case reports that showed the efficacy and safety of bronchoscopic bullectomy with one-way valves in the treatment of giant bullae. [8][9][10][11] Determining the location of a giant bulla and confirming the bulla is supplied by the bronchus is essential for valve treatment. Nevertheless, in some patients, it is difficult for the transposition of giant bullae caused by its high tension.…”

Who Should be Referred for Lung Volume Reduction Treatment?

“…5 Treatment with EBVs in carefully selected patients has provided statistically signifi cant benefi ts in lung function, exercise tolerance, dyspnoea and quality of life. 5,6…”

Case reports: narratives highlighting clinical experiences that inform practice and future research studies

“…The authors of a case report 1 describe the success and safety of treating a 65-year-old patient admitted to the hospital with severe COPD and huge emphysematous bullae in the right middle lobe and bronchoscopic lung volume reduction (BLVR). They placed an endobronchial valve in the right middle bronchus after confirming that there was no collateral ventilation 1 .…”

“…The authors of a case report 1 describe the success and safety of treating a 65-year-old patient admitted to the hospital with severe COPD and huge emphysematous bullae in the right middle lobe and bronchoscopic lung volume reduction (BLVR). They placed an endobronchial valve in the right middle bronchus after confirming that there was no collateral ventilation 1 . The authors describe the complete treatment regimen given to the patient and report that the huge bullae remained small one week later and disappeared at two months, with the improvement of pulmonary function, symptoms, and quality of life with no signs of obstruction, pneumonia, or pneumothorax.…”

“…In the case report described above, 1 the authors report their experience treating a patient with a specific clinical pattern of COPD with BLVR, because patients with both COPD and giant emphysematous bullae have been excluded from previous treatment studies. The reason for excluding patients with this clinical presentation was that this type of emphysema is a predictor of operative mortality.…”