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.
Highlights
Giant bullous emphysema (GBE) involves the presence of emphysematous areas with complete destruction of lung tissue producing an airspace bigger than 1cm in diameter
GBE, sometimes referred to as Vanishing Lung Syndrome (VLS) as a clinical syndrome, was first described by Burke in a typical patient: a young male cigarette smoker with a large bullae in the upper lobe associated with paraseptal emphysema [2]
We suggest to deflate the bulla and squeeze it between the endoclamps so the base of the giant bulla becomes visible without injuring healthy lung tissue and possibly provoking air leaks
Summary
Giant bullous emphysema (GBE) involves the presence of emphysematous areas with complete destruction of lung tissue producing an airspace bigger than 1cm in diameter. The bullous area does not participate in broncho-alveolar oxygenation and can cause dyspnoea, hypoxia, symptomatic chest pain or pressure, haemoptysis etc It can result in spontaneous pneumothorax, pneumothorax provoked by mechanical ventilation, infection and even slow progression to malignancy. GBE, sometimes referred to as Vanishing Lung Syndrome (VLS) as a clinical syndrome, was first described by Burke in a typical patient: a young male cigarette smoker with a large bullae in the upper lobe associated with paraseptal emphysema [2]. A routine chest X-ray was performed and suggested an apical pneumothorax on the left side, though HRCT showed a massive bulla of the left lung, with a 10 cm diameter, occupying the whole upper left hemithorax, with signs of centrilobular emphysema on the right side [Figure 1A-C]. One year follow-up revealed no recurrence, no intercostal pain syndrome and preserved pulmonary function
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