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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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2
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Raoof S, Shah M, Braman S, Agrawal A, Allaqaband H, Bowler R, Castaldi P, DeMeo D, Fernando S, Hall CS, Han MK, Hogg J, Humphries S, Lee HY, Lee KS, Lynch D, Machnicki S, Mehta A, Mehta S, Mina B, Naidich D, Naidich J, Ohno Y, Regan E, van Beek EJR, Washko G, Make B. Lung Imaging in COPD Part 2: Emerging Concepts. Chest 2023; 164:339-354. [PMID: 36907375 PMCID: PMC10475822 DOI: 10.1016/j.chest.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/13/2023] Open
Abstract
The diagnosis, prognostication, and differentiation of phenotypes of COPD can be facilitated by CT scan imaging of the chest. CT scan imaging of the chest is a prerequisite for lung volume reduction surgery and lung transplantation. Quantitative analysis can be used to evaluate extent of disease progression. Evolving imaging techniques include micro-CT scan, ultra-high-resolution and photon-counting CT scan imaging, and MRI. Potential advantages of these newer techniques include improved resolution, prediction of reversibility, and obviation of radiation exposure. This article discusses important emerging techniques in imaging patients with COPD. The clinical usefulness of these emerging techniques as they stand today are tabulated for the benefit of the practicing pulmonologist.
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Affiliation(s)
- Suhail Raoof
- Northwell Health, Lenox Hill Hospital, New York, NY.
| | - Manav Shah
- Northwell Health, Lenox Hill Hospital, New York, NY
| | - Sidney Braman
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Dawn DeMeo
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | - James Hogg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Ho Yun Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Sungkyunkwan University, ChangWon, South Korea
| | - Kyung Soo Lee
- Sungkyunkwan University School of Medicine, Samsung ChangWon Hospital, ChangWon, South Korea
| | | | | | | | | | - Bushra Mina
- Northwell Health, Lenox Hill Hospital, New York, NY
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3
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Costa R, Paiva A, Maciel J, Fernandes P, Magalhaes A. Surgery for pulmonary giant bullae. PNEUMON 2023. [DOI: 10.18332/pne/159280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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4
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Hosseinzadeh Asli R, Aghajanzadeh M, Lahiji MR, Hosseinzadeh Asli H, Foumani AA, Pourahmadi Y. Results of the surgical treatment of pulmonary bleb and bullous disease: A retrospective study. Lung India 2022; 39:455-459. [PMID: 36629207 PMCID: PMC9623867 DOI: 10.4103/lungindia.lungindia_735_21] [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: 12/28/2021] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 01/14/2023] Open
Abstract
Objective Bullous lung disease is characterised by the development of bullae within the lung parenchyma. Smoking is considered as a main risk factor of bullae formation. The clinical manifestation varies from asymptomatic bullae to severe respiratory distress. The exact medical approach is still controversial. Here, we aimed to evaluate the patient clinical characteristics and the indication of surgery in the patients. Methods This study was an analytic cross-sectional study in Razi hospital, Rasht, Iran, in 2016-2020. A total of 110 patients with newly diagnosed lung bullae underwent evaluation based on a checklist, which assessed the variables as clinical characteristics, bullae features, the medical treatment, and its complication. Eventually, statistical analysis was performed by using SPSS v21.0. Results : A total of 110 patients were enrolled. All the patients were smokers. In 72.9%, the primary presentation was respiratory distress, which needed surgical resection with no recurrence over 8 months. The clinical manifestation varies from asymptomatic bullae in 4.3% and pneumonia in 34.3% to respiratory distress in 61.4%. There was no statistical correlation between clinical manifestation and all the studied variables excluding respiratory distress (p value: 0.659). Seventy patients underwent surgical treatment, in which 20 cases were complicated by air leak that was managed by the chest tube in 16 patients and the Heimlich valve in four patients. No evidence of recurrence was detected. Conclusion The main risk factor of bulla formation is smoking. Because of various clinical presentations, the appropriate medical approach is of paramount importance.
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Affiliation(s)
- Rastin Hosseinzadeh Asli
- Department of Thoracic and General Surgery, Guilan University of Medical Sciences, Rasht, Iran
- Department of General Surgery, Aria Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Manouchehr Aghajanzadeh
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahtab Raji Lahiji
- Department of Thoracic and General Surgery, Guilan University of Medical Sciences, Rasht, Iran
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ali Alavi Foumani
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousha Pourahmadi
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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5
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Lin H, Zhang H, Yang D, Chen X, Chen Y, Song D, Cai C, Zeng Y. Bronchoscopic Treatment of Giant Emphysematous Bullae with Endobronchial Silicone Plugs. Int J Chron Obstruct Pulmon Dis 2022; 17:1743-1750. [PMID: 35945961 PMCID: PMC9357389 DOI: 10.2147/copd.s369803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Surgical bullectomy is the standard treatment of giant emphysematous bulla (GEB). However, bronchoscopic treatment should be considered as an alternative approach for patients who are unfit for surgical treatment. The study aimed to evaluate the clinical efficacy of endobronchial occlusion for the treatment of GEB using silicone plugs. Methods This retrospective study recruited four patients with GEB who were unsuitable for surgery. Preoperative planning was performed using high-resolution computed tomography and a virtual bronchoscopic navigation system. Customized silicone plugs were then placed in the target airway via bronchoscopy to cause GEB regression and atelectasis. Results All procedures were completed successfully in four patients. Three months after the procedures, compared with baseline, increases in the mean forced expiratory volume in 1 s (from 1.20 L/s to 1.33 L/s), forced vital capacity (from 2.63 L to 2.90 L), diffusion lung capacity for carbon monoxide (from 29% to 41% of the predicted value) and 6-minute walking test (from 412 m to 474 m) were observed. Additionally, the mean total lung capacity (from 6.80 L to 6.35 L), residual volume (from 3.97 L to 3.52 L), and St. George’s Respiratory Questionnaire scores (from 67 to 45) were all lower than baseline data. Conclusion Our preliminary results demonstrated that the endobronchial placement of silicone plugs could be a low-cost, safe, and effective choice for the treatment of GEB in surgically unfit patients.
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Affiliation(s)
- Huihuang Lin
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Huaping Zhang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Dongyong Yang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Xiaoyang Chen
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Yunfeng Chen
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Duanhong Song
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
| | - Chi Cai
- Department of Radiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| | - Yiming Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, People’s Republic of China
- Correspondence: Yiming Zeng, Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, No. 34, Zhongshanbei Road, Licheng District, Quanzhou, People’s Republic of China, Tel +86 13515042402, Fax +86 0595 22770258, Email
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Saini N, Nar A, Jabbal HS, Mishra A, Bains MS. Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India. Cureus 2022; 14:e25769. [PMID: 35702639 PMCID: PMC9177938 DOI: 10.7759/cureus.25769] [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] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease. Method: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them. Results: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%. Conclusion: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.
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7
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Kolodii M, Azzam S, Peer M. Thoracoscopic giant lung bullaectomy: our initial experience. J Cardiothorac Surg 2022; 17:37. [PMID: 35292061 PMCID: PMC8922855 DOI: 10.1186/s13019-022-01780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background Giant lung bullae (GLB) are rare, and the only currently available management involves either an open surgical resection (thoracotomy) or the newer minimally invasive resection consisting of video-assisted thoracoscopic surgery (VATS). The aim of our study was to evaluate the possible influence of GLBs pulmonary attachment on patient's post-operative complications. Methods A retrospective analysis included all consecutive patients with GLBs who underwent bullae's surgical resection from 7/2007 to 12/2018. GLBs patient's individual characteristics, including demographics, comorbidities, and clinical pre-operative, surgical intra-operative and post-operative data were evaluated. Results 20 patients with GLBs, 15 males and 5 females with average age of 48.9 years (range, 22–67 years) underwent 21 surgical procedures. The GLBs were located in the right lung in 12 patients, in the left lung in seven patients, and in both lungs in one patient. Fifteen patients (75%) were symptomatic on admission and underwent urgent surgery. Five asymptomatic patients (25%) were operated on electively. Thirteen from 21 surgical procedures (61.9%) were VATS bullectomy, while the other eight were thoracotomies (38.1%). Complications included pneumonia successfully treated with intravenous antibacterial therapy in two thoracotomy patients and in one VATS patient (three patients, 14.2%) and a prolonged air leak in two thoracotomy and four VATS patients (six patients, 28.5%). Out of 21 GLBs, eight had a wide attachment with lung parenchyma (wide-based bullae's) and 13 had a short attachment (short-based bullae's). Two re-operated patients, with prolonged air leak complicated with empyema, had a wide-based GLBs. The median hospital stay was nine days. All patients completed the 24-month follow-up. Conclusions Minimally invasive video-assisted thoracoscopic surgery as an open thoracotomy surgery is a safe and effective for giant lung bullae (GLB). Patients with wide-based GLBs were more likely to develop postoperative prolonged air leak that requiring re-operation.
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Affiliation(s)
- Marina Kolodii
- Department of Thoracic Surgery, Tel Aviv Medical Center, Affiliated with Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Sharbel Azzam
- Department of Thoracic Surgery, Tel Aviv Medical Center, Affiliated with Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Michael Peer
- Department of Thoracic Surgery, Tel Aviv Medical Center, Affiliated with Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, Tel Aviv, Israel.
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8
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Im Y, Jeong BH, Park HY, Kim TS, Kim H. Expeditious Resolution of Giant Bullae with Endobronchial Valves and Percutaneous Catheter Insertion. Yonsei Med J 2022; 63:195-198. [PMID: 35083906 PMCID: PMC8819409 DOI: 10.3349/ymj.2022.63.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/04/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022] Open
Abstract
As bullae contribute to decreased lung function in chronic obstructive pulmonary disease (COPD) patients, effective decompression of large bullae is important. Bronchoscopic lung volume reduction via endobronchial one-way valves is less invasive and has a lower mortality rate than lung volume reduction surgery. We report the case of a 48-year-old male who presented with giant bullae that were expeditiously resolved with endobronchial valves and percutaneous catheter insertion. Three days later, imaging revealed marked decreases in the extent of bullae and atelectasis of the contralateral lung without any complications, including air leakage or pneumothorax. Combination of endobronchial valves and percutaneous catheter insertion might be helpful to accelerate the release of large bullae and to achieve improved lung function and higher levels of physical activity in patients with COPD.
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Affiliation(s)
- Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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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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Zatloukal J, Brat K, Neumannova K, Volakova E, Hejduk K, Kocova E, Kudela O, Kopecky M, Plutinsky M, Koblizek V. Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:325-356. [PMID: 33325455 DOI: 10.5507/bp.2020.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.
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Affiliation(s)
- Jaromir Zatloukal
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Neumannova
- Department of Physiotherapy, Faculty of Physical Culture, Palacky University Olomouc, Czech Republic
| | - Eva Volakova
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Eva Kocova
- Department of Radiology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ondrej Kudela
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Michal Kopecky
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Koblizek
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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12
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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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13
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Kawamoto N, Hayashi M, Okita R, Okada M, Inokawa H, Kobayashi T, Maeda T, Ikeda E. Treatment strategy for primary lung cancer in a lung highly compressed by giant emphysematous bullae: A case report. Thorac Cancer 2020; 12:268-271. [PMID: 33174376 PMCID: PMC7812065 DOI: 10.1111/1759-7714.13739] [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: 10/16/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 12/05/2022] Open
Abstract
Lung cancer sometimes develops on the wall of a giant emphysematous bulla (GEB). Herein, we describe a rare case in which lung cancer developed in lung tissue compressed by GEBs. A 62‐year‐old man underwent a computed tomography (CT) scan that revealed two right GEBs. A tumor was suspected in the highly compressed right upper lobe. Since the right bronchus was significantly shifted toward the mediastinum, it was difficult to perform a bronchoscopy. We inserted thoracic drains into the GEBs, and a subsequent CT scan revealed re‐expansion of the remaining right lung and a 3.3 cm tumor in the right upper lobe. The shift of the right bronchus was improved, and bronchoscopy was performed. The tumor was diagnosed as non‐small cell lung cancer (NSCLC). Additionally, the GEBs were found to have originated from the right lower lobe. We performed a right upper lobectomy, mediastinal lymph node dissection, and bullectomy of the GEBs via video‐assisted thoracoscopic surgery. In preoperative evaluation of a GEB, assessing re‐expansion and lung lesions of the remaining lung is important, and intracavity drainage of a GEB may be useful. Key points Significant findings of the studyCancer that develops in lung tissue highly compressed by a giant emphysematous bulla is difficult to diagnose. In the preoperative evaluation of a giant emphysematous bulla, assessing re‐expansion and lung lesions of the remaining lung is important.
What this study addsAfter performing intracavity drainage of a giant emphysematous bulla, the remaining lung re‐expands, and the bronchial shift improves; subsequently, bronchoscopy makes it possible to diagnose lung cancer in the remaining lung.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Masataro Hayashi
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Riki Okita
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Masanori Okada
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Hidetoshi Inokawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Taiga Kobayashi
- Department of Radiology, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Tadashi Maeda
- Department of Medical Oncology, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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14
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Abstract
Patients with severe chronic obstructive pulmonary disease who fail maximal medical therapy and bronchoscopic interventions have surgical options to improve lung function, quality of life, and exercise performance. Carefully selected patients with upper lobe predominant emphysema can consider lung volume reduction surgery. Patients with upper lobe-predominant emphysema and low exercise performance have a survival advantage. Patients with large bulla compressing adjacent lung tissue occupying more than one-third of the lung benefit from bullectomy. Patients with advanced chronic obstructive pulmonary disease ineligible for or failing other surgical or bronchoscopic interventions can consider lung transplantation if free from major comorbidities.
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Affiliation(s)
- Sean Duffy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA.
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
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15
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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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16
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Management of Acute Hypercapnic Respiratory Failure Using Intrabronchial Valve Placement for Giant Emphysematous Bullae. J Bronchology Interv Pulmonol 2020; 27:e5-e8. [PMID: 31856013 DOI: 10.1097/lbr.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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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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18
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Zhu C, Chen Z, Chen B, Zhu H, Rice-Narusch W, Cai X, Shen J, Yang C. Thoracoscopic Treatment of Giant Pulmonary Bullae. J Surg Res 2019; 243:206-212. [DOI: 10.1016/j.jss.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/30/2022]
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19
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Intrabullous Adhesion Pexia (IBAP) by Percutaneous Pulmonary Bulla Centesis: An Alternative for the Surgical Treatment of Giant Pulmonary Bulla (GPB). Can Respir J 2018; 2018:5806834. [PMID: 30425754 PMCID: PMC6218743 DOI: 10.1155/2018/5806834] [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: 06/16/2018] [Revised: 08/26/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022] Open
Abstract
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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20
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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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21
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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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22
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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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23
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24
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Benito Bernáldez C, Almadana Pacheco V. Spontaneous Regression of Pulmonary Emphysematous Bulla. Arch Bronconeumol 2016; 53:347-348. [PMID: 27814927 DOI: 10.1016/j.arbres.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
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25
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Kemp SV, Herth FJF, Shah PL. Bullectomy: A Waste of Space or Room for Improvement? Respiration 2016; 92:218-219. [PMID: 27606836 DOI: 10.1159/000448762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Samuel V Kemp
- The National Institute for Health Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and Imperial College, London, UK
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26
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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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27
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Ostridge K, Wilkinson TMA. Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J 2016; 48:216-28. [PMID: 27230448 DOI: 10.1183/13993003.00041-2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
Computed tomography (CT) is the modality of choice for imaging the thorax and lung structure. In chronic obstructive pulmonary disease (COPD), it used to recognise the key morphological features of emphysema, bronchial wall thickening and gas trapping. Despite this, its place in the investigation and management of COPD is yet to be determined, and it is not routinely recommended. However, lung CT already has important clinical applications where it can be used to diagnose concomitant pathology and determine which patients with severe emphysema are appropriate for lung volume reduction procedures. Furthermore, novel quantitative analysis techniques permit objective measurements of pulmonary and extrapulmonary manifestations of the disease. These techniques can give important insights into COPD, and help explore the heterogeneity and underlying mechanisms of the condition. In time, it is hoped that these techniques can be used in clinical trials to help develop disease-specific therapy and, ultimately, as a clinical tool in identifying patients who would benefit most from new and existing treatments. This review discusses the current clinical applications for CT imaging in COPD and quantification techniques, and its potential future role in stratifying disease for optimal outcome.
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Affiliation(s)
- Kristoffer Ostridge
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
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28
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Topalovic M, Helsen T, Troosters T, Janssens W. Unexpected improvements of lung function in chronic obstructive pulmonary disease. Respir Med Case Rep 2016; 18:81-4. [PMID: 27330959 PMCID: PMC4901175 DOI: 10.1016/j.rmcr.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 11/17/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is usually characterized by a progressive decline of lung function. We reported the 10 years follow-up of an elderly man, a heavy smoker with severe COPD and apical bullous emphysema. During 6 months pulmonary rehabilitation program the patient’s clinical state improved significantly and it associated with a steep increase in forced expiratory volume in one second (FEV1). This case report elaborates on the unexpected gain of FEV1 in the follow-up of a COPD patient.
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Affiliation(s)
- Marko Topalovic
- Respiratory Medicine, University Hospital Leuven, Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Tuur Helsen
- Respiratory Medicine, University Hospital Leuven, Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Wim Janssens
- Respiratory Medicine, University Hospital Leuven, Department of Clinical and Experimental Medicine, KU Leuven, Belgium
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29
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Successful Treatment of Bulla with Endobronchial Valves. Case Rep Pulmonol 2015; 2015:947403. [PMID: 26347843 PMCID: PMC4549532 DOI: 10.1155/2015/947403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022] Open
Abstract
Emphysematous bullae are a complication of end-stage COPD. Patients with large bullae and poor respiratory function have limited treatment options. Surgical resection is a recognized treatment, but functional improvement after bullectomy is not satisfactory in patients with forced expiratory volume in 1 s (FEV1) < 35% predicted. When this 59-year-old male end-stage COPD patient was assessed, he was cachectic and lung function tests showed a FEV1 of 0.56 L (19% predicted) and a RV of 7 L (314% predicted), while 6MWT was 315 m and MRC dyspnea score was 4. Chest X-ray revealed a massive bulla of 10 cm in diameter in the right middle lobe. A fibrobronchoscopy was performed under local anesthesia and 2 Zephyr 4.0 valves were placed in the right middle lobe. Chest X-ray and CT scan performed 36 days later showed the complete resolution of the bulla. Seven months later, the patient demonstrated an improvement in FEV1 (+30%) and a decrease in RV from 314 to 262% predicted. This case report shows that the Zephyr valves may be successfully used to treat a large bulla in the right middle lobe in a patient with diffuse emphysema and severely impaired lung function.
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30
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Fei J, Marill KA. ECG phasic voltage changes associated with spontaneous pneumothorax in a patient with vanishing lung syndrome. BMJ Case Rep 2015; 2015:bcr-2014-207498. [PMID: 25618882 DOI: 10.1136/bcr-2014-207498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Alternating or phasic ECG voltage changes are most commonly associated with intrinsic myocardial electrophysiological perturbations or mechanical oscillation within a pericardial effusion. Rare descriptions of electrical alternation have been reported with pneumothorax. We present a case of a 53-year-old woman with vanishing lung syndrome who presented with spontaneous left pneumothorax and phasic ECG voltage changes that resolved after re-expansion of the lung.
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Affiliation(s)
- Jeffrey Fei
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keith A Marill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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31
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Tian Q, An Y, Xiao BB, Chen LA. Treatment of giant emphysamous bulla with endobronchial valves in patients with chronic obstructive pulmonary disease: a case series. J Thorac Dis 2015; 6:1674-80. [PMID: 25589959 DOI: 10.3978/j.issn.2072-1439.2014.11.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/18/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Giant emphysamtous bulla (GEB) can negatively affect the pulmonary functions of chronic obstructive pulmonary diseases (COPD) patients, including decreased forced expiratory volume in 1 s (FEV1) and increased functional residual capacity (FRC). The aim of this study was to evaluate the efficacy of endobronchial valve (EBV) to treat bullae and to find efficacy predictors of successful treatment. METHODS Five COPD patients with giant bulla were treated using EBVs. Before the EBV deployment, collateral ventilation (CV) between the targeted and adjacent lobes was evaluated with Chartis system. RESULTS In the two patients with negative CV, the mean value of FEV1 increased from 27.1±11.4% of predicted value before EBV treatment to 32.8±12.0% (P>0.05) at 1 month after EBV treatment, than to 31.7±24.5% (P>0.05) at 6 months after EBV treatment. Only one patient, whose bulla occupied the whole right middle lung, displayed sustained improvement of FEV1 at 6 months after EBV treatment. In the three patients with positive CV, the mean value of FEV1 decreased from 28.8±19.0% of predicted value before EBV treatment to 24.8±12.6% (P>0.05) at 1 month after EBV treatment, than to 22.1±10.8% (P>0.05) at 6 months after EBV treatment. CONCLUSIONS EBV is an effective measure to treat highly selected COPD patients with giant bulla. Although, EBV treatment can achieve transient improvement of lung function at patients with CV negative bulla, long-term benefit was merely observed at the patient with a bulla at right middle lobe (RML).
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Affiliation(s)
- Qing Tian
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yang An
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Bin-Bin Xiao
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Liang-An Chen
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing 100853, China
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32
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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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33
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Autobullectomie post-infectieuse. Rev Mal Respir 2014; 31:859-63. [DOI: 10.1016/j.rmr.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
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34
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Affiliation(s)
- C-T Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - S-Y Chang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
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Huang W, Han R, Li L, He Y. Surgery for giant emphysematous bullae: case report and a short literature review. J Thorac Dis 2014; 6:E104-7. [PMID: 24977015 DOI: 10.3978/j.issn.2072-1439.2014.04.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/18/2014] [Indexed: 11/14/2022]
Abstract
Giant bullous emphysema (GBE), known as 'vanishing lung syndrome', usually occurs in association with chronic obstructive pulmonary disease (COPD). In this report, we describe a patient with giant emphysematous bulla occupying approximately 95% of the right hemithorax, who had history of repeated attacks of acute exacerbation of COPD. About 95% of right pulmonary parenchyma was removed. Delightfully, the 5% of residual lung compressed for 4 years gradually inflated, and occupied the whole hemithorax. Preoperatively he was functionally and clinically severely disabled while improved markedly after bullectomy.
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Affiliation(s)
- Wenting Huang
- 1 Department of Thoracic Surgery, 2 Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Rui Han
- 1 Department of Thoracic Surgery, 2 Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Li Li
- 1 Department of Thoracic Surgery, 2 Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Yong He
- 1 Department of Thoracic Surgery, 2 Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing 400042, China
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36
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Abstract
As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is probably underused. Rapid progress is being made in nonsurgical approaches to lung volume reduction, but use outside specialized centers cannot be recommended presently. Noninvasive ventilation given to patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease reduces mortality and morbidity, but the place of chronic non-invasive ventilatory support remains more controversial.
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Affiliation(s)
- Patrick Brian Murphy
- Lane Fox Clinical Respiratory Physiology Group, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Zaid Zoumot
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Michael Iain Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
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37
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Krishnamohan P, Shen KR, Wigle DA, Allen MS, Nichols FC, Cassivi SD, Harmsen WS, Deschamps C. Bullectomy for Symptomatic or Complicated Giant Lung Bullae. Ann Thorac Surg 2014; 97:425-31. [DOI: 10.1016/j.athoracsur.2013.10.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
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38
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Ambrosino N, Ribechini A, Allidi F, Gabbrielli L. Use of endobronchial valves in persistent air leaks: a case report and review of the literature. Expert Rev Respir Med 2014; 7:85-90. [DOI: 10.1586/ers.12.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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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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40
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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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41
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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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42
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Dickhoff C, Hartemink KJ, Slebos DJ, Symersky P, Vonk-Noordegraaf A. Extrathoracic proof of intrathoracic trouble. Thorax 2013; 69:785. [PMID: 23897946 DOI: 10.1136/thoraxjnl-2013-203847] [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]
Affiliation(s)
- C Dickhoff
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - K J Hartemink
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - D J Slebos
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - P Symersky
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vonk-Noordegraaf
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
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Shariff MA, Singh VA, Daniele ED, Goyal N, Peykova D, Nabagiez JP, Rosell FM. Spontaneous collapse of bilateral bullae with conservative management. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2013; 6:107-11. [PMID: 23843717 PMCID: PMC3700969 DOI: 10.4137/ccrep.s11187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of bilateral apical lung bullae that collapsed following an episode of community-acquired pneumonia with bilateral air fluid levels. With standard treatment for community-acquired pneumonia, management of a patient that may have qualified for bullectomy, (as in our case) showed complete resolution of all pathology without surgical intervention. Conservative management took precedence in alleviating pathology over surgical intervention.
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Affiliation(s)
- Masood A Shariff
- Department of Cardiothoracic Surgery, Staten Island University Hospital, 475 Seaview Ave, Staten Island, New York 10305
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44
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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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45
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Gunnarsson SI, Johannesson KB, Gudjonsdottir M, Magnusson B, Jonsson S, Gudbjartsson T. Incidence and outcomes of surgical resection for giant pulmonary bullae--a population-based study. Scand J Surg 2013; 101:166-9. [PMID: 22968239 DOI: 10.1177/145749691210100305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Giant pulmonary bullae (GPB) are rare and there is little information on incidence, long-term prognosis, and outcome of treatment. OBJECTIVES To assess the incidence of GPB in the Icelandic population and to evaluate the outcome of surgical treatment. METHODS Twelve consecutive patients (11 males; mean age 60 ± 15.7 years) underwent resection for GPB in Iceland between 1992 and 2009. All were heavy smokers and had bullae occupying > 30% of the involved lung. There were 8 bilateral and 3 unilateral bullectomies and one lobectomy. Pulmonary function tests were performed preoperatively, and at one month and 5.4 years postoperatively. Age-standardized incidence rate (ASR) was calculated, complications and operative mortality were registered, and overall survival was estimated. Mean follow-up time was 8.2 years. RESULTS The ASR for GPB was 0.40 and 0.03 per 100,000 per year for men and women, respectively. There was no operative mortality, but prolonged air leakage (75%) and pneumonia (17%) were the most common postoperative complications. One month postoperatively, mean FEV1 increased from 1.0 ± 0.48 L (33% predicted) to 1.75 ± 0.75 L (57.5% predicted) (p < 0.01), but FVC remained unchanged. RV decreased from 3.9 ± 0.8 L (177% predicted) to 3.0 ± 1.0 L (128% predicted) (p < 0.05), but TLC and DLCO did not change after operation. At long-term follow-up the FEV1 and FVC had declined to near-baseline values. Five-year and 10-year survival were 100% and 60%, respectively. CONCLUSIONS The ASR of GPB in Iceland was 0.21 per 100,000 per year. In this small series, bullectomy was found to be a safe procedure that significantly improved pulmonary function. The functional improvement then declined over time. Prolonged air leakage was a common postoperative complication that prolonged hospital stay.
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Affiliation(s)
- S I Gunnarsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
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46
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Kayawake H, Chen F, Date H. Surgical resection of a giant emphysematous bulla occupying the entire hemithorax. Eur J Cardiothorac Surg 2013; 43:e136-8. [PMID: 23333837 DOI: 10.1093/ejcts/ezs699] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Surgical bullectomy is the treatment of choice for giant emphysematous bullae; however, when a giant emphysematous bulla occupies the entire hemithorax, and the remaining lung is in a collapsed state for a long period, it is difficult to predict the surgical outcome preoperatively. We report a case of the successful resection of a giant emphysematous bulla occupying the entire hemithorax. A 44-year old man presented with bilateral giant emphysematous bullae. The giant emphysematous bulla on the left side occupied the entire left hemithorax. Further investigation of past chest radiographs helped predict that the left lung could be re-expanded with the recovery of pulmonary function after resection of the giant emphysematous bulla.
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47
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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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48
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Affiliation(s)
- Yu-Tzu Tsao
- Department of Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
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49
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Wu Y, Han B, Wang ZG, Chen X, Wu JM. Huge pulmonary bulla with gastroesophageal reflux: a case report. Shijie Huaren Xiaohua Zazhi 2012; 20:891-893. [DOI: 10.11569/wcjd.v20.i10.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The pulmonary bulla is a common clinical entity, but huge pulmonary bulla with gastroesophageal reflux (GER) is rare. Huge pulmonary bulla with gastroesophageal symptoms is easily misdiagnosed as GER with asthma-like symptoms. Our case completely recovered after a correct diagnosis and surgical treatment, which stresses the importance of understanding the causes of GER symptoms, especially extra-gastroesophageal causes.
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50
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Choi EY, Kim WS. Regression of Large Lung Bullae after Peribullous Pneumonia or Spontaneously. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Young Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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