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Ascano MP, Kramer N, Le K. Differentiating Giant Bullous Emphysema From Tension Pneumothorax: A Case Report. Cureus 2024; 16:e55988. [PMID: 38606232 PMCID: PMC11007189 DOI: 10.7759/cureus.55988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Giant bullous emphysema (GBE) is a progressive disease that commonly presents with severe progressive dyspnea attributed to the progressive destruction of alveolar walls and the formation of large air pockets, resulting in impaired gas exchange. This presentation is most commonly seen in young, thin male smokers. GBE poses an interesting and unique clinical challenge due to its radiologic findings, which can be easily mistaken for tension pneumothorax. Despite the decreased acuity of GBE as compared to tension pneumothorax, inadequate treatment in a severe case can lead to spontaneous pneumothorax, infection, and/or respiratory failure. In this report, we highlight a case of severe GBE that presents similarly to tension pneumothorax in both symptomatology and radiologic findings. The case at hand is of a 50-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) with complaints of dyspnea and subsequent findings of tachycardia, tachypnea, and hypoxemia with significantly decreased breath sounds in the right lung. Radiologic findings showed increased lucency of the right hemithorax and a mass effect with a mediastinal shift to the left. History and further imaging with CT led to an ultimate diagnosis of severe GBE and COPD exacerbations. The patient was treated with non-invasive medical management. With the challenges of overlapping presentations, landing on the correct diagnosis is imperative to accurately and adequately treat the patient since GBE and tension pneumothorax significantly differ in acuity and overall management, hence the need for a high level of suspicion based on the clinical picture and the use of high-resolution CT.
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Affiliation(s)
| | - Nicholas Kramer
- College of Osteopathic Medicine, Touro University Nevada, Henderson, USA
| | - Khoa Le
- Department of Internal Medicine, North Vista Hospital, Las Vegas, USA
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Park J, Kim D, Park JH, Lee JY, Cho EJ. Cardiovascular Collapse after the Induction of Anesthesia Due to the MASS Effect of Unruptured Giant Bullae. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1689. [PMID: 37763808 PMCID: PMC10535054 DOI: 10.3390/medicina59091689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Giant bullae rupture easily and cause tension pneumothorax, which can cause problems during general anesthesia. However, the hemodynamic instability that can occur due to the mass effect of an unruptured giant bulla should not be overlooked. Case report: A 43-year-old male patient visited the emergency room with an abdominal wound. There was a giant emphysematous bulla in the left lung. Emergency surgery was decided upon because there was active bleeding according to abdominal CT. After tracheal intubation, the patient's blood pressure and pulse rate dramatically decreased. His blood pressure did not recover despite the use of vasopressors and discontinuation of positive pressure ventilation applied to the lungs. Thus, a bullectomy was immediately performed. The patient's blood pressure and pulse rate were normalized after the bullectomy. Conclusions: If emergency surgery under general anesthesia is required in a patient with a giant emphysematous bulla, it is safe to minimize positive pressure ventilation and remove the giant emphysematous bulla as soon as possible before proceeding with the remainder of the surgery. Tension pneumothorax due to the rupturing of a bulla should be considered first. However, hemodynamic changes might occur due to the mass effect caused by a giant bulla.
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Affiliation(s)
- Junghyun Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Dulee Kim
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Jae-Hoo Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Ji-Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Eun-Jung Cho
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
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Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS. Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report. Respir Med Case Rep 2020; 31:101276. [PMID: 33209576 PMCID: PMC7658491 DOI: 10.1016/j.rmcr.2020.101276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Nur Izat Muhamad
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Siti Nurbaya Mohd Nawi
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Corresponding author. Department of Medicine, School of Medical Sciences, Kampus Kesihatan Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Bazli Md Yusoff
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noor Azizah Ab Halim
- Department of Radiology, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Nurashikin Mohammad
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Syamimee Wan Ghazali
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Bajaj T, Malik B, Thangarasu S. Tension Bullae With Peripheral Pneumothorax. J Investig Med High Impact Case Rep 2020; 8:2324709620963646. [PMID: 33030072 PMCID: PMC7550932 DOI: 10.1177/2324709620963646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The differentiation between tension bullae, chronic tension pneumothorax, and atypical pneumothorax is difficult just from history and physical examination alone. A chest X-ray may help determine the underlying etiology; however, further imaging with computed tomography in stable patients may be necessary for accurate assessment of size, number, and location before considering any interventions. In this article, we present a rare case report of tension bullae with peripheral pneumothorax and recommend against needle thoracostomy in stable patients with tension bullae in order to obtain further imaging that may result in a change in the standard management.
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Cocaine-Induced Giant Bullous Emphysema. Case Rep Med 2020; 2020:6410327. [PMID: 32454835 PMCID: PMC7225852 DOI: 10.1155/2020/6410327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
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.
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Lung ultrasound for pneumothorax in children: relevant limits. Pediatr Radiol 2020; 50:451-452. [PMID: 32065274 DOI: 10.1007/s00247-020-04621-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/10/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
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Quarato CMI, Tinti MG, Sperandeo M. Comment on "Giant bullous emphysema mistaken for traumatic pneumothorax: A fatal case of pneumothorax" and role of the extended Focused Assessment with Sonography in Trauma (eFAST). Int J Surg Case Rep 2019; 60:307-308. [PMID: 31279235 PMCID: PMC6612001 DOI: 10.1016/j.ijscr.2019.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- C M I Quarato
- Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - M G Tinti
- Unit of Geriatric, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - M Sperandeo
- Unit of Interventional and Diagnostic, Ultrasound of Internal Medicine IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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