Giant bullous emphysema mistaken for traumatic pneumothorax

Ferreira, Edson Gonçalves; Costa, Philippos Apolinário; Silveira, Larissa Melo Freire Golveia; Almeida, Luis Enrique Maurera; Salvioni, Nayane Carolina Pertile; Loureiro, Bruna Menon

doi:10.1016/j.ijscr.2019.02.005

Cited by 14 publications

(17 citation statements)

References 19 publications

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“…It has been implicated with cigarette smoking, inhaled drug use such as marijuana, and intravenous drug use. Certain conditions such as alpha-1 antitrypsin deficiency, Marfan and Ehlers-Danlos Syndrome, and HIV infection have also been associated with VLS [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report

Muhamad

Nawi

Yusoff

et al. 2020

Respiratory Medicine Case Reports

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Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

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Section: Discussionmentioning

confidence: 99%

“…VLS is frequently misdiagnosed as pneumothorax by clinicians [ [4] , [5] , [6] ]. Distinguishing VLS from pneumothorax requires careful interpretation of the chest radiograph and requires confirmation with high-resolution computer tomography (HRCT) of the thorax [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report

Muhamad

Nawi

Yusoff

et al. 2020

Respiratory Medicine Case Reports

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“…Due to its rare occurrence, cocaine-induced giant bullous emphysema is often confused for a possible underlying pneumothorax. Imaging studies should be performed in patient's suspected with bullae as chest tube placement has been associated with high flow fistulas leading to worse outcomes [15]. e rapid identification using imaging modalities and immediate treatment for bullous emphysema can lead to improved patient outcomes and decreased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Cocaine-Induced Giant Bullous Emphysema

Douedi

Upadhyaya

Patel

et al. 2020

Case Reports in Medicine

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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.

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“…We read with great interest the article by Edson et al [1]. where some important lessons can be learned.…”

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confidence: 99%

“…The absence of breath sounds, beside the concomitant presence of symptomatic chest pain, hypoxia and respiratory distress ideally require a detailed but also fast clinical assessment, before proceeding with invasive measure, such as chest tube placement as in the case described [1]. Indeed, the clinical picture of GBE may mimic and overlap with pneumothorax’s one, and a correct differential diagnosis imply the need of fast but also adequate radiologic assessment.…”

mentioning

confidence: 99%