Cavernas pulmonares gigantes cicatrizadas, no colapsadas que simulan bulas de enfisema

Abstract

Radiographic images and symptoms of healed non-collapsed pulmonary tuberculous cavities can mimic emphysematous bullae. Objective: To identify characteristics that facilitate the differential diagnosis between both entities, preoperatively. Material and methods: We present four patients treated between March and December 2010, referred to thoracic surgery with radiologic diagnosis of emphysematous giant bullae, previously treated by pulmonary tuberculosis. Results: The fi rst patient was operated on with diagnosis of giant emphysematous bulla. Pathological fi ndings defi ned the actual diagnosis: healed non-collapsed pulmonary cavity. Anamnesis and previous radiographies facilitated the differential diagnosis in the remaining three patients. Surgical indications were the presence of the cavity (> 8 cm) accompanied by mild to moderate dyspnea. A patient developed a bronchopleural fi stula, empyema and hemoptysis requiring antituberculous treatment due to the possibility of tuberculosis reactivation. Nonetheless, tuberculous bacillus was not demonstrated. Conclusions: In geographic areas with high prevalence of pulmonary tuberculosis, the history of this disease and the presence of pulmonary cavities in the affected lobe, after fi nishing the medical treatment, the diagnosis of healed non-collapsed cavity must be suspected, instead of emphysematous bullae.