Video-assisted Thoracoscopic Resection of a Giant Bulla in Vanishing Lung Syndrome: case report and a short literature review

Highlights The authors present a unique case of giant bullous emphysema in the context of a trauma evaluation. During initial trauma evaluation giant bullous emphysema can be misdiagnosed as pneumothorax. A computerized tomography scan can avoid catastrophic complications in patients with giant bullous emphysema, such as uncontrollable airway fistulas.

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“…In GBE, pneumothorax can be provoked by mechanical ventilation, recurrent infections, and even malignancy [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Giant bullous emphysema mistaken for traumatic pneumothorax

Ferreira

Costa

Silveira

et al. 2019

International Journal of Surgery Case Reports

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“…However, for GPB or GEB, especially tension GPB, invasive therapy might be inevitable. Surgical intervention, such as bullectomy or lobectomy, may alleviate symptoms, improve exercise tolerance, and prevent fatal respiratory distress, and it is considered as the routine technique of choice in treating GPB [ 6 , 14 ]. However, contraindications or complications with the open procedure hamper their clinical application in critical cases, especially for elderly patients [ 1 , 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Intrabullous Adhesion Pexia (IBAP) by Percutaneous Pulmonary Bulla Centesis: An Alternative for the Surgical Treatment of Giant Pulmonary Bulla (GPB)

Yang

et al. 2018

Canadian Respiratory Journal

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Background and Objective Most patients with giant pulmonary bulla (GPB) are treated by surgery; however, there is a subset for whom surgery is not a viable option, such as those with contraindications, or those unwilling to undergo operation. Therefore, an alternative minimally invasive method is desired for this subpopulation. The aim of this study was to explore an alternative procedure for treating GPB. Methods This was a prospective, nonrandomized, single-arm, unblinded study evaluating the efficacy and safety of intrabulla adhesion pexia (IBAP) procedure in GPB patients. The study was conducted between December 2004 and April 2017. Results There were 38 cases in 36 patients (33 males and 3 females) with the target GPB cavities varying in size (range, 10 cm × 7 cm × 5 cm to 15 cm × 8 cm × 30 cm (anteroposterior diameter × medial-lateral diameter × superoinferior diameter)). After IBAP treatment, the closure ratio of GPB in one month was 86.84% (33/38), while the dyspnea index significantly decreased from 4.11 ± 1.11 to 2.24 ± 1.15 (P < 0.01). In addition, the mean FEV1 (L) increased from 1.06 ± 0.73 to 1.57 ± 1.13 (P < 0.01), while RV (L) decreased from 2.77 ± 0.54 to 2.36 ± 0.38 (P < 0.01) and TLC (L) decreased from 6.46 ± 1.21 to 5.86 ± 1.08 (P < 0.01). Moreover, PaO2 (mmHg) increased from 52.18 ± 8.31 to 68.29 ± 12.34, while the 6 MWD increased by 129.36% from 131.58 ± 105.24 to 301.79 ± 197.90 (P < 0.01). Collectively, these data indicated significant improvement in pulmonary function and exercise tolerance after IBAP treatment. Furthermore, no deaths occurred during IBAP treatment, and no cases of aggravated GPB relapse were reported during the 12-month follow-up period. Conclusions IBAP is a promising strategy for the treatment of GPB. Our findings demonstrated that IBAP had a noteworthy therapeutic effect, desirable safety, and ideal long-term efficacy for GPB.

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“…In subsequent publications, this phenomenon has mostly been described in young and middle-aged men as a single giant bulla or multiple bullae related pathology developing on the adjacent normal lung tissues under pressure (3)(4)(5)(6)(7)(8)(9). Some authors have used the term "vanishing lung" to refer to the radiographic appearance in which lung tissue is completely destructed due to progression of emphysema (1, 2, 10, 11).…”

Section: öZetmentioning

confidence: 99%

Vanishing Lung Syndrome: A Rare Entity

2015

J Turgut Ozal Med Cent

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Vanishing lung syndrome is characterised by giant bullae that compress the underlying lung. Differentiating between bullous emphysema and pneumothorax and choosing the right treatment modality can be challenging. The present report describes a case of a giant pulmonary bulla in a young male patient. A 20-year-old male was admitted with complaints of shortness of breath, chest pain, sweating, and tachycardia. Chest X-ray and chest CT images revealed the presence of giant bullae occupying the left hemithorax and pneumothorax. A chest tube was inserted percutaneously under local anesthesia into the pleural cavity and then we performed bullectomy using thoracoscopic surgery. Residual lung re-expansion yielded good postoperative results without complications. It can be very difficult to distinguish a pneumothorax from a giant bulla and preoperative assessment of the extent and distribution of the bullae is vital for the following procedures. Keyword: Giant Bulla; Pulmonary Emphysema; Pneumothorax.Vanishing Lung Sendrom: Nadir Bir Antite Özet Vanishing lung sendrom nadir görülen ve dev bül veya büllerin akciğerin büyük oranda kollapsına neden olduğu bir antitedir. Bu çalışmada solunum sıkıntısı, terleme, çarpıntı şikayeti ile acil servise başvuran 20 yaşında, radyografik olarak sağ hemitoraksın tümünü kaplayan dev bül ve çevresinde pnömotoraks saptanan bir erkek hasta sunuldu. Hastaya tüp torakostomi uygulandı ve daha sonra torakoskopik cerrahi ile bül eksizyonu yapıldı. Postoperatif dönemde komplikasyon gelişmedi. Akciğer ekspanse olan olgu postop 6. günü şifa ile externe edildi. Vanishing lung sendromunda en önemli sıkıntı bül, pnömotoraks ayrımının yapılmasında ve altta yatan akciğer parankiminin ne derece sağlıklı olduğunun değerlendirilmesinde yaşanılan zorluktur. Uygun vakalarda bül eksizyonu ile kollabe akciğerin ekspanse olur ve tam bir klinik düzelme sağlanır.

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Video-assisted Thoracoscopic Resection of a Giant Bulla in Vanishing Lung Syndrome: case report and a short literature review

Cited by 16 publications

References 15 publications

Giant bullous emphysema mistaken for traumatic pneumothorax

Giant bullous emphysema mistaken for traumatic pneumothorax

Intrabullous Adhesion Pexia (IBAP) by Percutaneous Pulmonary Bulla Centesis: An Alternative for the Surgical Treatment of Giant Pulmonary Bulla (GPB)

Vanishing Lung Syndrome: A Rare Entity

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