Cocaine-Induced Giant Bullous Emphysema

Abstract

Background. Emphysematous bullae, defined as airspaces of greater than or equal to one centimeter in diameter, have a variety of etiologies such as tobacco use and alpha-1 antitrypsin being the most common. Emphysematous bullae have also been reported in patients using cocaine usually involving the lung periphery and sparing the central lung parenchyma. We present a case of a male with a history of cocaine abuse found to have a singular giant emphysematous bulla occupying >95% of the right hemithorax requiring video-assisted thoracic surgery (VATS) with a favorable outcome. Case Presentation. A 50-year-old male with a history of chronic cocaine abuse was found unresponsive in the field and given multiple doses of naloxone without any improvement in mental status. On presentation to the emergency department, chest X-ray as well as CT scan of the chest were performed which were suggestive of an extensive pneumothorax of the right lung requiring placement of a chest tube. The patient was subsequently intubated and underwent bronchoscopy with right chest VATS which found a giant bulla encasing the entire right pleural cavity. During the procedure, he underwent resection of the bullae and a partial right pleurodesis. After the procedure, patient’s respiratory status significantly improved, and he was discharged in a stable condition. Conclusion. Cocaine use is a rare but identifiable factor that can cause giant bullous emphysema (GBE) resulting in severe complications and even death. The purpose of this case presentation is to support early identification and treatment of GBE using bullectomy with VATS, improving outcomes and decreasing morbidity and mortality.

Elective over emergency: The role of precise diagnosis in managing Giant bullae in COPD patients - A case report

“…This chronic inflammation and subsequent damage cause a reduction in gas exchange efficiency and airflow due to the decreased elastic recoil of the chest wall [ 7 , 12 ]. Additionally, the inflammatory process contributes to structural changes in the airways, including increased mucous gland growth and fibrosis [ 1 , 15 ]. These changes further worsen lung function by obstructing airways and limiting gas exchange capacity, leading to chronic hypoxia and increased carbon dioxide levels in patients [ 3 , 7 ].…”

“…A chest X-ray might show the bullae, but a chest CT scan is essential for confirming their presence, excluding pneumothorax, and assessing their size and location. Misdiagnosing as pneumothorax might not only create immediate health risks but could also lead to unnecessary procedures and complications [ 12 , 15 ]. A confirming CT scan in this case diagnosed the presence of a large bulla in the right lung, steering the treatment plan towards elective bullectomy.…”