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Escalon JG, Girvin F. Smoking-Related Interstitial Lung Disease and Emphysema. Clin Chest Med 2024; 45:461-473. [PMID: 38816100 DOI: 10.1016/j.ccm.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Diagnosis and treatment of patients with smoking-related lung diseases often requires multidisciplinary contributions to optimize care. Imaging plays a key role in characterizing the underlying disease, quantifying its severity, identifying potential complications, and directing management. The primary goal of this article is to provide an overview of the imaging findings and distinguishing features of smoking-related lung diseases, specifically, emphysema/chronic obstructive pulmonary disease, respiratory bronchiolitis-interstitial lung disease, smoking-related interstitial fibrosis, desquamative interstitial pneumonitis, combined pulmonary fibrosis and emphysema, pulmonary Langerhans cell histiocytosis, and E-cigarette or vaping related lung injury.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA.
| | - Francis Girvin
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA
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2
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Mansour M, Kessler S, Khreisat A, Morton J, Berghea R. Vanishing Lung Syndrome: A Case Report and Systematic Review of the Literature. Cureus 2024; 16:e53443. [PMID: 38314388 PMCID: PMC10838376 DOI: 10.7759/cureus.53443] [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: 02/02/2024] [Indexed: 02/06/2024] Open
Abstract
Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung tissue. The elusive etiology of VLS mandates a diagnosis based on radiographic evidence showcasing giant bullae occupying at least one-third of the hemithorax in one or both lungs. This report presents a case of VLS in a 36-year-old female smoker devoid of any prior medical history. Additionally, we conducted a systematic review to discern the demographics, risk factors, and treatment modalities for individuals diagnosed with VLS.
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Affiliation(s)
- Meghan Mansour
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Steven Kessler
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Jacob Morton
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Ramona Berghea
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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3
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Velez Oquendo G, Balaji N, Ignatowicz A, Qutob H. Vanishing Lung Syndrome in a Young Male With Chronic Marijuana Use: A Case Report. Cureus 2023; 15:e51223. [PMID: 38283438 PMCID: PMC10821717 DOI: 10.7759/cureus.51223] [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: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Vanishing lung syndrome (VLS) also known as type I bullae disease or idiopathic bullous disease is characterized by giant emphysematous bullae that commonly develop in the upper lobes, occupying at least one-third of a hemithorax. It is a progressive and irreversible condition that involves pulmonary parenchymal destruction and alveolar dilation. It is commonly associated with middle-aged tobacco smokers, habitual marijuana users, and those with alpha-1-antitrypsin deficiency. This case involves an incarcerated male in his 30s with chronic marijuana smoking who presented with a three-month history of right-sided chest pain accompanied by cough, hemoptysis, fever, and weight loss. The patient reported month-long atypical chest discomfort associated with a cough productive of bloody sputum and was brought to the ED after developing acutely worsening right-sided chest pain. The patient underwent a chest X-ray that revealed a large pneumothorax on the left. Subsequently, CT chest imaging showed extensive bilateral bullous disease, left upper lobe consolidation, and enlarged mediastinal lymph nodes. This case illustrates a rare presentation of VLS in the setting of a young patient who other than reported regular marijuana use had no other risk factors and a negative workup for possible etiologies that could cause his severe bullous emphysema, including alpha-1 antitrypsin, HIV, Sjogren's syndrome, pulmonary Langerhans cell histiocytosis, two sputum Mycobacterium tuberculosis tests, and acid-fast bacteria sputum cultures, which were all negative. Identifying and assessing the degree of disease early in this progressive disease helps guide treatment while preventing further deterioration of lung parenchyma.
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Affiliation(s)
| | - Nivedha Balaji
- Internal Medicine, Northeast Georgia Medical Center Gainsville, Gainesville, USA
| | | | - Hisham Qutob
- Critical Care, Northeast Georgia Medical Center Gainsville, Gainesville, USA
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4
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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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5
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Louis M, Hastings JC, Jones L, Singh H. Elective over emergency: The role of precise diagnosis in managing Giant bullae in COPD patients - A case report. Int J Surg Case Rep 2023; 110:108750. [PMID: 37660493 PMCID: PMC10509829 DOI: 10.1016/j.ijscr.2023.108750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bullous lung disease, characterized by large air-filled spaces in lung tissue, includes a significant subset called "giant bullae," occupying over 30 % of a hemithorax, often linked to chronic obstructive pulmonary disease (COPD). Accurate differentiation between giant bullous emphysema and pneumothorax is crucial to prevent unintended interventions. Misdiagnosing as pneumothorax might lead to chest tube placement with associated complications, including hemothorax, empyema, continuous air leak, prolonging hospitalization and increasing healthcare costs. CASE PRESENTATION A 42-year-old male, with a COPD history and marijuana use, presented to the ED with recurring sharp right chest pain exacerbated by expiration and shortness of breath. Initial assessment raised pneumothorax suspicions. A medical history and chart review revealed a CT from five years prior, indicating a 6 cm bulla in the right upper lung. A confirming CT scan diagnosed a bulla, leading to elective bullectomy scheduling. CLINICAL DISCUSSION Distinguishing between giant bullous emphysema and pneumothorax is pivotal. This report underscores diagnostic precision's importance, accentuating therapeutic considerations for lung bullae in COPD patients. Misdiagnosis risks chest tube placement, necessitating awareness of associated complications. CONCLUSION This case highlights accurate diagnosis's importance and differential analysis. Misdiagnosis repercussions, from patient care to costs, underscore the diagnosis's critical significance. This extends to urgency scenarios, emphasizing diagnosis's role in patient outcomes optimization. The case confirmed a giant bulla diagnosis, prompting elective bullectomy without chest tube placement.
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Affiliation(s)
- Mena Louis
- Northeast Georgia Medical Center, General Surgery GME Program, Gainesville, GA 30501, USA.
| | - John Clifton Hastings
- Northeast Georgia Medical Center, Northeast Georgia Physicians Group Surgical Associates, Cardiothoracic Surgery, Gainesville, GA 30501, USA.
| | - Louise Jones
- Northeast Georgia Medical Center, Graduate Medical Education Research Department, Gainesville, GA 30501, USA.
| | - Hardeep Singh
- Northeast Georgia Medical Center, 743 Spring St NE, Gainesville, GA 30501, USA.
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Goyal VD, Pahade A, Misra G. Excision of a giant lung bulla in a child: Repair of bronchial leaks using redundant bullous wall/membrane. Asian Cardiovasc Thorac Ann 2022; 31:269-272. [PMID: 36544276 DOI: 10.1177/02184923221147094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Large lung bullae are rare in children. We report a rare case of a large bulla in the right lung causing compression of the underlying lung with a shift of the mediastinum to the contralateral side. Excision of the bulla was done and a novel technique was used in the repair of bronchial air leakage sites with part of the bullous wall/membrane. The patient recovered well with re-expansion of the underlying collapsed lung.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
| | - Akhilesh Pahade
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
| | - Gaurav Misra
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
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7
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Muacevic A, Adler JR, Sengupta S. Giant Bullous Emphysema Mimicking Spontaneous Pneumothorax. Cureus 2022; 14:e31182. [PMID: 36505170 PMCID: PMC9727579 DOI: 10.7759/cureus.31182] [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: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Emphysema is a progressive and degenerative lung disease that most commonly occurs due to many years of smoking or exposure to smoke and irritants. It is also seen in the congenital absence of the alpha-1-antitrypsin enzyme. Bullous emphysema is an advanced stage of the disease where strictures of the bronchi permit the inspired air to enter the bronchi but close on expiration, causing air retention and alveolar dilation, destruction, and atrophy. Multiple small bullae coalesce to form a giant bulla (defined as occupying more than one-third of the hemithorax), which causes respiratory symptoms and mediastinal shifting and leads to a poor general condition of the patient. Here, we present the cases of two patients diagnosed with bullous emphysema who presented within three months of each other. This article details the similarities and differences in the approach to both cases and the learning experience from these presentations, especially in acute symptomatology. Bullous emphysema is usually confused with a pneumothorax on a simple chest X-ray; hence, it is imperative to look for the lung margins and confirm the diagnosis using computed tomography of the thorax.
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Garvey S, Faul J, Cormican L, Eaton D, Judge EP. Symptomatic unilateral idiopathic giant bullous emphysema : a case report. BMC Pulm Med 2022; 22:341. [PMID: 36085045 PMCID: PMC9463853 DOI: 10.1186/s12890-022-02135-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic Giant Bullous Emphysema (or Vanishing Lung Syndrome) is a rare condition which is usually associated with male gender, active smoking and underlying emphysematous disease. We present an unusual case of a giant bulla occurring in the absence of these risk factors.
Case presentation A 54-year-old woman presented to the respiratory outpatient clinic with gradually worsening left sided chest discomfort, which was most marked during a recent flight. She had no significant dyspnoea or other symptoms. She had a remote 5-pack-year smoking history. Chest X-Ray revealed a large hyperlucent area in the left upper lobe. CT Thorax found this to be an isolated bulla occupying more than one-third of the hemithorax. The remaining lung parenchyma was normal. A diagnosis of Idiopathic Giant Bullous Emphysema was made. The patient was referred for VATS (Video-assisted thoracoscopic surgery) bullectomy which was carried out without complication. Her symptoms resolved completely following the operation. Conclusions This is an unusual case of a solitary giant bulla occurring without major risk factors or underlying lung disease. VATS bullectomy was shown to be an effective therapeutic option, allowing re-expansion of compressed lung tissue and complete resolution of symptoms.
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Heo J, Bak SH, Ryu SM, Hong Y. Tuberculosis-Infected Giant Bulla Treated by Percutaneous Drainage Followed by Obliteration of the Pulmonary Cavity Using Talc: Case Report. J Chest Surg 2021; 54:408-411. [PMID: 33262316 PMCID: PMC8548197 DOI: 10.5090/jcs.20.107] [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] [Received: 08/11/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/05/2022] Open
Abstract
Tuberculosis (TB)-infected giant bullae are rare. A 55-year-old man was referred when an infected bulla did not respond to empirical treatment. Computed tomography showed a giant bulla in the right upper lobe with an air-fluid level and surrounding infiltrate. Sputum culture, acid-fast bacilli (AFB) stain, and polymerase chain reaction (PCR) for TB were negative. Percutaneous drainage of the bullous fluid was performed. AFB stain and PCR were positive in the drained fluid. The patient was given anti-TB drugs and later underwent obliteration of the pulmonary cavity using talc. To summarize, we report a patient with a TB-infected giant bulla that was treated successfully with anti-TB drugs and obliteration of the pulmonary cavity using talc.
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Affiliation(s)
- Jeongwon Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.,Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Se Min Ryu
- Department of Thoracic and Cardiovascular Surgery, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yoonki Hong
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.,Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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10
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Lin X, Wang H, Yang Y, Xiang H. Anesthetic management for resection of a giant emphysematous bulla: a case report. J Int Med Res 2021; 49:3000605211001989. [PMID: 33853431 PMCID: PMC8059042 DOI: 10.1177/03000605211001989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Anesthetic management for patients with a giant emphysematous bulla (GEB) is challenging. This case report describes a patient who developed 95% pulmonary compression by a GEB. A 14-Ga indwelling catheter was placed in the GEB before surgery to allow for slow re-expansion of the collapsed lung tissue. This prevented rupture of the GEB during anesthesia. Additionally, positive-pressure ventilation was performed to reduce the risk of re-expansion pulmonary edema. This respiratory management strategy may be beneficial for patients with a GEB who develop pulmonary dysfunction during thoracic surgery.
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Affiliation(s)
- Xianju Lin
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, P.R. China.,Department of Anesthesiology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 317000, P.R. China
| | - Hongzhu Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, P.R. China
| | - Yong Yang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, P.R. China.,Department of Anesthesiology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 317000, P.R. China
| | - Haifei Xiang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, P.R. China.,Department of Anesthesiology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 317000, P.R. China
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11
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Hamad AMM, Elmahrouk AF, Elmistekawy EM. Respiratory Distress and Chest Pain in an Airplane Passenger With Radiolucent Left Hemithorax. Chest 2021; 159:e319-e323. [PMID: 33965156 DOI: 10.1016/j.chest.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/08/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
CASE PRESENTATION A 43-year-old man experienced sudden onset of chest pain and shortness of breath onboard a domestic flight. After consultation with the airline's operations center, a decision was made to land the plane in its destination airport. After landing, an ambulance was ready, and the patient was transferred to the ED in our facility. Patient evaluation was immediately started, and oxygen supply and venous access were secured.
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Affiliation(s)
- Abdel-Mohsen M Hamad
- King Fahad Specialist Hospital, Buraydah, Saudi Arabia; Faculty of Medicine, Tanta University, Tanta, Egypt.
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12
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El Kaddouri B, Strand MJ, Baraghoshi D, Humphries SM, Charbonnier JP, van Rikxoort EM, Lynch DA. Fleischner Society Visual Emphysema CT Patterns Help Predict Progression of Emphysema in Current and Former Smokers: Results from the COPDGene Study. Radiology 2021; 298:441-449. [PMID: 33320065 PMCID: PMC8824777 DOI: 10.1148/radiol.2020200563] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The correlation between visual emphysema patterns and subsequent progression of disease may provide a way to enrich a study population for treatment trials of emphysema. Purpose To evaluate the potential relationship between emphysema visual subtypes and progression of emphysema and gas trapping. Materials and Methods Current and former smokers with and without chronic obstructive pulmonary disease (COPD) enrolled in the prospective Genetic Epidemiology of COPD (COPDGene) study (ClinicalTrials.gov identifier: NCT02445183) between 2008 and 2011 had their Fleischner Society visual CT scores assessed at baseline, quantitative inspiratory, and expiratory CT and at 5 years. They also underwent pulmonary function testing at baseline CT and at 5 years. The dependent variables were inspiratory lung density at 15th percentile (adjusted for lung volume) as a measure of emphysema and percentage of lung volume with attenuation less than -856 HU at expiratory CT as a measure of air trapping. Statistical analysis used a linear mixed model, adjusted for age, height, sex, race, smoking status, and scanner make. Results A total of 4166 participants (mean age, 60 years ± 9 [standard deviation]; 2091 [50%] men) were evaluated. In participants with COPD (1655 participants, 40%), those with visual presence of mild, moderate, and confluent emphysema at baseline CT showed a mean decline in lung density of 4.6 g/L ± 1.1 (P < .001), 6.7 g/L ± 1.1 (P < .001), and 6.4 g/L ± 1.2 (P < .001), respectively, compared with 2.4 g/L ± 1.3 (P < .001) for those with trace emphysema. For participants without COPD, those with visual presence of mild and moderate emphysema at baseline CT showed a mean decline in lung density of 3.6 g/L ± 1.0 (P < .001) and 3.1 g/L ± 1.6 (P < .001), respectively, compared with 1.8 g/L ± 1.0 (P < .001) for those with trace emphysema. Conclusion The pattern of parenchymal emphysema at baseline CT was an independent predictor of subsequent progression of emphysema in participants who are current or former cigarette smokers with and without chronic obstructive pulmonary disease. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Bilal El Kaddouri
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Matthew J Strand
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - David Baraghoshi
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Stephen M Humphries
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Jean-Paul Charbonnier
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Eva M van Rikxoort
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - David A Lynch
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
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13
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Chang CH, Ko HJ. Giant bulla or pneumothorax. Postgrad Med J 2020; 98:e51. [PMID: 37066591 DOI: 10.1136/postgradmedj-2020-139077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Chia-Hao Chang
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Huan-Jang Ko
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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14
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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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15
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Hossain S, Hossain A, Barajas-Ochoa A. Chest pain in a middle-aged smoker with heart failure and missing lung. Eur J Intern Med 2020; 81:87-88. [PMID: 32980219 DOI: 10.1016/j.ejim.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Hossain
- American University of Antigua, Jabberwock Beach Road, PO Box W1451, Coolidge, Antigua.
| | - Afif Hossain
- Department of Medicine, Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ 07107.
| | - Aldo Barajas-Ochoa
- Department of Medicine, Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ 07107.
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16
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Yousaf MN, Chan NN, Janvier A. Vanishing Lung Syndrome: An Idiopathic Bullous Emphysema Mimicking Pneumothorax. Cureus 2020; 12:e9596. [PMID: 32923201 PMCID: PMC7478520 DOI: 10.7759/cureus.9596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vanishing lung syndrome (VLS) is also referred to as idiopathic giant bullous emphysema and is a rare manifestation of chronic obstructive pulmonary disease (COPD). Middle-aged tobacco smokers, younger marijuana users, and those with alpha-1-antitrypsin deficiency may especially be affected. The clinical and radiographic findings of VLS may initially be misinterpreted as spontaneous pneumothorax. High-resolution CT is the diagnostic imaging modality of choice in these patients and can help to differentiate VLS from pneumothorax. Such imaging also helps guide appropriate management. Management of VLS ranges from a conservative to a surgical approach depending upon patients' comorbidities and candidacy for surgical resection. We present a case of a 64-year-old man with frequent hospitalizations for COPD exacerbation admitted with worsening shortness of breath and was found to have giant bullae mimicking a pneumothorax on the initial presentation.
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Affiliation(s)
- Muhammad N Yousaf
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Internal Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Nim N Chan
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, Medstar Good Samaritan Hospital, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Adrien Janvier
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Georgetown University, School of Medicine, Washington, DC, USA
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17
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Horiuchi K, Asakura T, Ochi J, Saito F. Pneumothorax associated with giant bullous emphysema and mediastinum deviation. BMJ Case Rep 2019; 12:12/12/e230353. [PMID: 31852689 DOI: 10.1136/bcr-2019-230353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kohei Horiuchi
- Department of Pulmonary Medicine, Eiju General Hospital, Taito-ku, Tokyo, Japan
| | - Takanori Asakura
- Department of Pulmonary Medicine, Eiju General Hospital, Taito-ku, Tokyo, Japan.,Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Junichi Ochi
- Department of Pulmonary Medicine, Eiju General Hospital, Taito-ku, Tokyo, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Taito-ku, Tokyo, Japan
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18
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Ferreira Junior EG, Costa PA, Silveira LMFG, Almeida LEM, Salvioni NCP, Loureiro BM. Giant bullous emphysema mistaken for traumatic pneumothorax. Int J Surg Case Rep 2019; 56:50-54. [PMID: 30826593 PMCID: PMC6402233 DOI: 10.1016/j.ijscr.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Giant bullous emphysema (GBE) is defined by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding parenchyma [1]. Symptoms include dyspnea, hypoxia, chest pain and pressure, and hemoptysis [2], which can be complicated by pneumothorax and infection of the bullae [3]. CASE PRESENTATION A 50-year-old male was brought to the emergency department after he fell 5 m in a suicide attempt. The patient was in respiratory distress and had bilateral absence of breath sounds. He was intubated and bilateral chest tubes were inserted. A computerized tomography (CT) scan showed bilateral giant bullous emphysema in the upper lobes, confirming a diagnosis of GBE. As a result of the insertion of chest tubes, he developed bilateral high flow fistulas. During his hospitalization, he developed sepsis secondary to ventilator-associated pneumonia. In an attempt to control the fistulas, a right bullectomy was performed. Despite antibiotic treatment and surgical intervention, the patient died due to septic shock. DISCUSSION The clinical picture of a patient with GBE can be similar to that of pneumothorax, and GBE has been reported as being misdiagnosed as pneumothorax [4,5]. A CT scan can play an important role in differentiating these conditions [6], thus avoiding needle decompression, which can be catastrophic [6]. CONCLUSION Giant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement.
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Affiliation(s)
| | - Philippos Apolinario Costa
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
| | | | - Luis Enrique Maurera Almeida
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
| | | | - Bruna Menon Loureiro
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
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Park S, Shi H, Wang S, Lee S, Ko Y, Park YB. Complete resolution of the giant pulmonary bulla: a case of inflammatory autobullectomy. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.
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20
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An J, Long M, Jiang Y, Jin Y. Concomitant a giant pulmonary bulla on the left lower lobe and hamartoma successfully treated by video-assisted thoracoscopic pulmonary wedge resection. AME Case Rep 2018; 1:2. [PMID: 30263989 DOI: 10.21037/acr.2017.09.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022]
Abstract
A 48-year-old woman was admitted for pectoralgia and dyspnea. Tomography revealed a giant lung bulla with a mass arose from the bulla wall in the left lower lobes, and left lower lobes pulmonary wedge resection was performed through video-assisted thoracic surgery (VATS). The giant bulla was formed by fibrous connective tissue covered by monolayer pavement epithelium. The trabecular bone, cartilage and adipose tissue were found in the nodular lesion. The final diagnosis was giant pulmonary bulla with hamartoma, a very rare condition and previously unreported in the literature. Surgical approach for complete resection of the bulla was a curative treatment.
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Affiliation(s)
- Jun An
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Meijun Long
- Breast Cancer Center and Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yi Jin
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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21
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Shannon VR, Nanda AS, Faiz SA. Marfan Syndrome Presenting as Giant Bullous Emphysema. Am J Respir Crit Care Med 2017; 195:827-828. [PMID: 28186842 DOI: 10.1164/rccm.201610-2062im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vickie R Shannon
- 1 Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Amit S Nanda
- 2 University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
| | - Saadia A Faiz
- 1 Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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22
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Abstract
Giant bullae often mimic pneumothorax on radiographic appearance. We present the case of a 55-year-old man admitted to a referring hospital with dyspnea, cough, and increasing sputum production; he refused thoracotomy for tension pneumothorax and presented to our hospital for a second opinion. A computed tomography (CT) scan at our hospital revealed a giant bulla, which was managed conservatively as an exacerbation of chronic obstructive pulmonary disease. Thoracic surgery was consulted but advised against bullectomy. Giant bullae can easily be misdiagnosed as a pneumothorax, but the management of the two conditions is vastly different. Distinguishing between the two may require CT scan. Symptomatic giant bullae are managed surgically. We highlight the etiology, presentation, diagnosis, and treatment of bullous lung disease, especially in comparison to pneumothorax.
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Affiliation(s)
- Yunhee Im
- Department of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Texas
| | - Saad Farooqi
- Department of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Texas
| | - Adan Mora
- Department of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Texas
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23
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Chen MT, Tang SE. Tuberculosis-related giant bullae mimicking tension pneumothorax. Intern Emerg Med 2017; 12:1069-1070. [PMID: 28039614 DOI: 10.1007/s11739-016-1601-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Ming-Tsung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan, ROC
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan, ROC.
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25
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Abstract
With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). The aim of this pictorial essay was to improve the understanding of primary spontaneous pneumothorax and to propose a description of the major anatomical lesions found during surgery.
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Affiliation(s)
- Roberto de Menezes Lyra
- Serviço de Cirurgia Torácica, Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil.,Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE - São Paulo (SP) Brasil
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26
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Young Man With Sudden Onset of Shortness of Breath. Ann Emerg Med 2017; 69:264-272. [DOI: 10.1016/j.annemergmed.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Indexed: 11/29/2022]
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27
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Dua R, Singhal A. Localized Hyperlucency in an Acutely Dyspneic Patient: Always a Pneumothorax? J Emerg Med 2016; 51:e7-e9. [PMID: 27241715 DOI: 10.1016/j.jemermed.2016.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Every emergency physician encounters acutely dyspneic patients with localized hyperlucency on chest x-ray study. Although most commonly due to pneumothorax, alternative diagnosis in selected cases with atypical features includes bullae and cystic lesions, especially in childhood. Presence of atypical radiology shouId alert an emergency physician to rule out any alternative diagnosis. Computed tomography is usually diagnostic in such cases and a double-wall sign on computed tomography aids to distinguish between pneumothorax and bullous disease. CASE REPORT A 60-year-old male presented with sudden increase in dyspnea and a localized hyperlucency on chest x-ray study. A review of his medical records and evaluation of atypical radiology by computed tomography revealed increase in size of bulla to be the cause for distress rather than a pneumothorax. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Every emergency physician encountering acutely dyspneic patients should be aware of these potential mimickers of pneumothorax and ways to distinguish them to avoid inadvertent tube thoracostomy and possible complications.
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Affiliation(s)
- Ruchi Dua
- Department of Pulmonary Medicine, Aiims Rishikesh, Uttarakhand, India
| | - Ankit Singhal
- Department of Pulmonary Medicine, Aiims Rishikesh, Uttarakhand, India
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28
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Desai P, Steiner R. Images in COPD: Giant Bullous Emphysema. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 3:698-701. [PMID: 28848895 DOI: 10.15326/jcopdf.3.3.2016.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Parag Desai
- Thoracic Medicine and Surgery, Temple University Health System, Philadelphia, Pennsylvania
| | - Robert Steiner
- Thoracic Medicine and Surgery, Temple University Health System, Philadelphia, Pennsylvania.,Department of Radiology, Temple University Health System, Philadelphia, Pennsylvania
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29
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Goud A, Krimsky W, Caldwel M, Perry B, Heiraty P, Sarkar S, Harley DP, Selinger S. Percutaneous Bullectomy in Conjunction with Endobronchial Valve Placement as an Alternative to Surgical Management of Giant Bullae. Respiration 2016; 91:523-6. [PMID: 27319018 DOI: 10.1159/000447245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/18/2016] [Indexed: 11/19/2022] Open
Abstract
We present the first reported case of the treatment and management of a giant bulla using percutaneous bullectomy and endobronchial valve placement. A 74-year-old woman with chronic obstructive pulmonary disease and a known large bulla in the left chest presented to the emergency department with acute-onset confusion after a traumatic fall. She was subsequently diagnosed with an intracranial hemorrhage in the distribution of the right basal ganglia. Chest imaging revealed a giant apical bulla occupying 80% of the left hemithorax. In addition, there was midline shift away from the affected side associated with volume loss in the right hemithorax and no radiographic evidence of aeration in the remainder of the left lung. Arterial blood gas analysis revealed significant hypercapnia. Surgical bullectomy was not an option, and thus, a novel approach was utilized to treat this patient.
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Affiliation(s)
- Aditya Goud
- Department of Internal Medicine, MedStar Franklin Square Hospital Center, Baltimore, Md., USA
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30
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Tarazi M, Mayooran N, Anwer M, Anjum MN, Doddakula K. A case of lung volume reduction surgery with decortication for a septic patient in respiratory failure. Int J Surg Case Rep 2015; 17:89-91. [PMID: 26588664 PMCID: PMC4701825 DOI: 10.1016/j.ijscr.2015.10.038] [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] [Received: 05/27/2015] [Revised: 10/22/2015] [Accepted: 10/31/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Decortication and lung volume reduction surgery are both major operations and each has its independent risk of morbidity and mortality. CASE REPORT We present the case of a 41 year old gentleman with left sided empyema and giant bullae of the upper lobe with an active air leak that was transferred to our tertiary referral centre for further management. We performed emergency left thoracotomy, decorticated the left lower lobe with extensive lung volume reduction surgery of the upper lobe. Patient's respiratory status significantly improved along with excellent radiological results. CONCLUSION Our case demonstrates that a combination of complex procedures is feasible with excellent outcomes.
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Affiliation(s)
- M Tarazi
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - N Mayooran
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - M Anwer
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - M N Anjum
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - K Doddakula
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
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Abstract
High-resolution chest computed tomography (CT) is one of the most useful techniques available for imaging bronchiolitis because it shows highly specific direct and indirect imaging signs. The distribution and combination of these various signs can further classify bronchiolitis as either cellular/inflammatory or fibrotic/constrictive. Emphysema is characterized by destruction of the airspaces, and a brief discussion of imaging findings of this class of disease is also included. Typical CT findings include destruction of airspace, attenuated vasculatures, and hyperlucent as well as hyperinflated lungs.
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Affiliation(s)
- Rachael M Edwards
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
| | - Gregory Kicska
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Rodney Schmidt
- Department of Pathology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Sudhakar N J Pipavath
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
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33
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Tay CK, Ng YL. A breath from Houdini - A case of giant bullous emphysema. Respir Med Case Rep 2014; 14:30-3. [PMID: 26029573 PMCID: PMC4356045 DOI: 10.1016/j.rmcr.2014.12.003] [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: 11/30/2022] Open
Abstract
We describe a case of a young man presenting with exertional dyspnea. His chest radiograph showed hyperlucency in his left lung, and he was subsequently diagnosed to have giant bullous emphysema. An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed. This is followed by a literature review of the clinical presentation, natural history, radiology and management of giant bullous emphysema. Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases. This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.
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Affiliation(s)
- Chee Kiang Tay
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Yuen Li Ng
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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34
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Mallat N, Limeme M, Zaghouani H, Amara H, Bakir D, Kraiem C. [A lung parenchymal cavitation]. Rev Mal Respir 2014; 31:871-3. [PMID: 25433595 DOI: 10.1016/j.rmr.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Affiliation(s)
- N Mallat
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie.
| | - M Limeme
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie
| | - H Zaghouani
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie
| | - H Amara
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie
| | - D Bakir
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie
| | - C Kraiem
- Service d'imagerie médicale, CHU Farhat Hached, rue Ibn Jazzar, 4000 Sousse, Tunisie
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35
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36
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Gao X, Wang H, Gou K, Huang B, Xia D, Wu X, Wei M, Zheng S, Ma S, He J. Vanishing lung syndrome in one family: five cases with a 20-year follow-up. Mol Med Rep 2014; 11:567-70. [PMID: 25322795 DOI: 10.3892/mmr.2014.2673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 07/31/2014] [Indexed: 11/05/2022] Open
Abstract
Vanishing lung syndrome, also known as idiopathic giant bullous emphysema, is a rare disease characterized by giant emphysematous bullae. The disease is diagnosed by radiological findings of giant bullae in one, or both, of the upper lobes of the lung, occupying at least one-third of the hemithorax. There have been several reports of vanishing lung syndrome, however it remains to be determined whether genetic inheritance is associated with the disease. In the present study, five patients within one family, with vanishing lung syndrome, were reported during a follow-up period of ~ 20 years. All of the patients were diagnosed by radiological findings, which showed diffuse bullae in the lungs, which were of varying size and asymmetrical distribution, and the occurrence of pneumothorax or emphysema. The Medical Ethics Committee of the People's Hospital of Zhangye Municipality (Zhangye, China) approved this study, and all subjects gave their informed consent During the follow-up period of 20 years, bullae in these patients were shown to progressively increase, and no other pulmonary diseases, including lung cancer, tuberculosis, pneumoconiosis and chronic bronchitis were observed. Autosomal dominant inheritance was observed in five cases, and autosomal recessive inheritance was observed in one case. The present study suggests that vanishing lung syndrome may be associated with autosomal dominant and recessive genetic inheritance.
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Affiliation(s)
- Xichun Gao
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Haiying Wang
- Department of Medicine, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Kaihong Gou
- Department of Obstetrics and Gynecology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Baosheng Huang
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Dongzhou Xia
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Xiuli Wu
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Ming Wei
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Shengxi Zheng
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Shan Ma
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
| | - Juanxiang He
- Department of Radiology, The People's Hospital of Zhangye Municipality, Zhangye, Gansu 734000, P.R. China
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37
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Vanishing Lung Syndrome in a Patient with HIV Infection and Heavy Marijuana Use. Case Rep Pulmonol 2014; 2014:285208. [PMID: 24511405 PMCID: PMC3910399 DOI: 10.1155/2014/285208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022] Open
Abstract
Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking.
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Van Bael K, La Meir M, Vanoverbeke H. Video-assisted Thoracoscopic Resection of a Giant Bulla in Vanishing Lung Syndrome: case report and a short literature review. J Cardiothorac Surg 2014; 9:4. [PMID: 24387696 PMCID: PMC3904682 DOI: 10.1186/1749-8090-9-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/26/2013] [Indexed: 11/17/2022] Open
Abstract
A 36-year-old Caucasian man was admitted to our hospital with acute onset of left-sided chest pain. Computed Tomography confirmed the presence of a giant bulla on the apex of the lower lobe of the left lung. A video-assisted thoracic surgery (VATS) with bullectomy was performed using two linear endostaplers. Additionally pleurectomy was performed. No serious complications occurred in the postoperative course, as the patient showed good lung re-expansion and no prolonged air leakage. VATS bullectomy is a suitable and eminent technique to approach giant bullous emphysema and definitely fulfils a role in its treatment.
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Affiliation(s)
- Kobe Van Bael
- Department of Cardiothoracic Surgery, ASZ Aalst, Merestraat 80, B-9300 Aalst, Belgium.
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Park JH, Kim J, Lee JK, Kim SJ, Lee AR, Moon HJ, Kim DK. A case of bilateral giant bullae in young adult. Tuberc Respir Dis (Seoul) 2013; 75:222-4. [PMID: 24348672 PMCID: PMC3861380 DOI: 10.4046/trd.2013.75.5.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022] Open
Abstract
Giant bullae are large bullae occupying at least one-third of the hemithorax and surgical bullectomy is the treatment of choice. We report a case with symptomatic giant bullae which were resected successfully. A 35-year-old man presented with bilateral giant bullae that occupied almost the entire left hemithorax and a third of the right hemithorax. He was a current smoker with a 30 pack-year history and he presented with dyspnea on exertion. An elective surgical bullectomy was performed with video-assisted thoracoscopic surgery. The patient recovered without any adverse events and stayed well for 1 month after surgery.
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Affiliation(s)
- Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ae-Ra Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jong Moon
- Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, New Taipei City Hospital, No 2 Chung-Shan Rd, San-Chong Dist, New Taipei City, Taiwan.
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Affiliation(s)
- Khalid Mohammad
- Division of Pulmonary and Critical Care Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cordova FC. Medical pneumoplasty, surgical resection, or lung transplant. Med Clin North Am 2012; 96:827-47. [PMID: 22793947 DOI: 10.1016/j.mcna.2012.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Over the last decade, advances in bronchoscopic and surgical techniques have expanded our treatment armamentarium for patients with severe emphysema who previously would have received a pessimistic outlook from their physician. Advances in our understanding of the different COPD phenotypes and its natural history has refined our selection process as to which group of emphysema patients will derive maximum benefit from LVR, bullectomy, or lung transplantation. Because emphysema is a progressive disease, initial treatment with bronchoscopic or surgical LVR or bullectomy does not preclude lung transplantation in the future.
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Affiliation(s)
- Francis C Cordova
- Lung and Heart/Lung Transplant Program, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Suga K, Iwanaga H, Tokuda O, Okada M, Matsunaga N. Intrabullous ventilation in pulmonary emphysema: assessment with dynamic xenon-133 gas SPECT. Nucl Med Commun 2012; 33:371-8. [PMID: 22227559 DOI: 10.1097/mnm.0b013e32834f264c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Intrabullous ventilation in patients with pulmonary emphysema (PE) was cross-sectionally evaluated using dynamic xenon-133 gas single photon emission computed tomography (SPECT). METHODS Fifty-two patients with PE with a total of 109 bullae of more than 4 cm in maximum diameter underwent xenon-133 gas SPECT. The real xenon-133 gas half-clearance time (T1/2) at each bulla was compared with that at the surrounding lung in the same lobe. The emphysema subtype of the surrounding lung was classified into centrilobular, panlobular, and paraseptal on computed tomography (CT). RESULTS All bullae except for one in all patients showed xenon-133 gas wash-in. Of the 108 bullae with wash-in, 95 (87.9%) bullae in 46 (88%) patients showed marked xenon-133 gas retention with a T1/2 beyond 110 s (mean: 184 s ± 91). The surrounding lungs of these bullae also showed marked retention with a T1/2 of greater than 100 s (mean: 174 s ± 82), and the majority (N=92, 96.8%) were centrilobular or panlobular on CT. The remaining 13 (12.0%) bullae in six (11%) patients showed minimal retention with a T1/2 of less than 80 s (mean: 62 s ± 11), regardless of no significant difference in size compared with the bullae with marked retention. All the surrounding lungs of these bullae except for one also showed minimal retention with a T1/2 of less than 70 s (mean: 60 s ± 18), which was significantly less compared with that of the bullae with marked retention (P<0.0001), and the majority (N=11, 84.6%) were paraseptal with or without an interstitially fibrotic change and predominantly located at the lower lung lobe on CT. The T1/2 of the 108 bullae with xenon-133 gas wash-in was significantly correlated with that of the surrounding lungs (r=0.884, P<0.0001). CONCLUSION Intrabullous ventilation in patients with PE appears to depend on the ventilation status of the surrounding lung, and bullae with the surrounding lungs of paraseptal-type emphysema tend to show minimal air trapping. Xenon-133 gas SPECT is useful for assessment of the interaction between intrabullous and surrounding lung's ventilation, which is difficult on CT.
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Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, St Hill Hospital, Yamaguchi, Japan.
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Affiliation(s)
- Yu-Tzu Tsao
- Department of Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
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A rare case of vanishing lung syndrome. Case Rep Pulmonol 2011; 2011:957463. [PMID: 22937434 PMCID: PMC3420501 DOI: 10.1155/2011/957463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 07/18/2011] [Indexed: 11/17/2022] Open
Abstract
We describe here a rare case of Idiopathic Bullous Emphysema/Vanishing Lung Syndrome (VLS) in a 33-year-old male patient with a history of marijuana abuse who presents to the hospital with pleuritic chest pain thought to be due to pneumothorax based on the chest radiograph. This case emphasizes the need to obtain chest computed tomography in a relatively stable patient suspected of VLS to reduce the potential risk of overseeing a bronchopleural fistula.
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Fuentes A, Alvarez S, Márquez E, Velasquez S. [Giant pulmonary bulla diagnosed as spontaneous pneumothorax]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:398. [PMID: 21797096 DOI: 10.1016/s0034-9356(11)70096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- A Fuentes
- Servicio de Anestesiologya y Reanimacidn, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona.
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