Symptomatic unilateral idiopathic giant bullous emphysema : a case report

Overdiagnosing giant bullous emphysema as metastatic adenocarcinoma: a case report

BACKGROUND

Giant bullous emphysema is characterized by large bullae occupying at least one-third of the hemithorax and leading to compression of the surrounding lung parenchyma. Overdiagnosis can occur because of the atypical appearance of hyperplastic type II pneumocytes, which may be mistaken for malignant cells.

CASE PRESENTATION

A 48-year-old male with a history of smoking and occupational exposure presented with dyspnea and drowsiness. Initial chest X-ray revealed a tension pneumothorax, and subsequent chest CT revealed extensive bullous emphysema and lung cancer in the right middle lobe (RML). Pathologic examination initially indicated resected bullae to metastatic adenocarcinoma, but upon review, it was determined that the reactive alveolar cells were misdiagnosed as malignant.

CONCLUSIONS

This case emphasizes the need for thorough histopathological assessment and prudent interpretation of atypical cellular morphology.

Vanishing Lung Syndrome: A Case Report and Systematic Review of the Literature

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.

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

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.