Since patient was symptomatic and there was radiological evidence of compression of surrounding lung tissue, surgical bullectomy was indicated. Giant bullae refers to the enlargement of one or more bullae occupying more than onethird of the hemithorax. Obviously the bullous area does not participate in. Bilateral giant pulmonary emphysematous bullae in a calf. Type 1 bullae have smooth internal lining without trabeculae and type 4 have trabec.
Giant apical bulla vanishing lung syndrome radiology. Giant bullae form when adjacent areas of paraseptal emphysema coalesce, and are therefore usually subpleural in distribution. We report a case with symptomatic giant bullae which were resected successfully. Giant bullous emphysema, originally described by burke in 1937, is an idiopathic, distinct clinical syndrome of severe progressive dyspnea caused by extensive, predominantly asymmetric upper lobe bullous emphysema, which may eventually lead to respiratory failure. Reduction pneumoplasty for giant bullous emphysema. Many physicians believe that cases of infectious giant bullae require surgical treatment. Andres f henaomartinez md, juan f fernandez md, sandra g adams md msc, and carlos restrepo md airfluid levels within emphysematous lung bullae are a relatively uncommon occurrence in patients with preexisting bullous disease, and are not commonly reported. Giant bullous emphysema gbe also referred to as primary bullous emphysema or vanishing lung syndrome, is characterized by bulla occupying at least one third of the hemithorax. A giant bulla is defined as a bulla occupying at least 30% of a hemithorax. As previously mentioned, infectious giant bullae cannot be successfully treated through antibiotic therapy alone. Videoassisted thoracoscopic treatment of giant bullae associated with emphysema. These air pockets tend to grow and put pressure on the lungs since it starts occupying the space.
Clinical features of primary lung cancer adjoining. A 60yearold caucasian man was admitted to our emergency department with progressive dyspnoea, chronic cough and general asthenia. Physical examination revealed lack of left chest wall motion and absent breath sounds over the left hemithorax. Nonsurgical management of giant lung bullae during mechanical ventilation article pdf available in respiratory care 5610. Giant bullae typically develop because of longterm cigarette smoking, which is the most likely cause in this case. A 35yearold man presented with bilateral giant bullae that occupied almost the entire left hemithorax and a third of the right hemithorax.
These areas threaten the patients health not only because of the underlying emphysema. Bulla or bullae for pleural is the term used for airfilled cavities within the lung tissue. Vanishing lung syndrome was first reported by burke in 1937 1, roberts first presents the radiographic criteria for this condition. A lung bullae can be caused by loss or damage of tissue in the lung. Management of longterm persistent air leakage developed. Giant bullae can gradually progress into tension bullae having growing mass effect on underlying lung parenchyma and mediastinum compromising lung ventilation and gaseous exchange. Lung function fev 1 and rv of all patients were measured using the spirometer and body plethysmography masterscreen gold standard. The term giant bulla is used for bullae that occupy at least 30 percent of a hemithorax. Giant bullous emphysema gbe, referred to as vanishing lung syndrome as a clinical syndrome, was first described by burke in 1937. On examination he was thin and hypoxic, with a silent, hyperresonant left hemithorax. Videoassisted thoracoscopic resection of a giant bulla in.
Nonsurgical management of giant lung bullae during. Giant bullous emphysema surgery can be an effective procedure for improving airflow and exercise capacity. As an air pocketa bulla grows, it takes up space in the chest cavity and can encroach on the lungs. Instead of returning to a standing position, immediately take a big step forward into a traditional bodyweight.
The case histories are presented of four men with multiple large upper zone lung bullae but otherwise relatively preserved lung parenchyma. Bullous and bleb diseases of the lung talat chughtai emilie perron mathieu simon jean deslauriers bullae were defined at the 1959 ciba symposium as emphysematous spaces larger than 1 cm in diameter in the inflated lung, usually but not necessarily demarcated from surrounding lung by curved hairline shadows. Confusion occasionally arises between the two entities because some pathologists regard bullous disease as a subset of panacinar emphysema. Median sternotomy for bilateral resection of emphysematous. Blebs, bullae and spontaneous pneumothorax thoracic surgery. Bullous disease of the lung fishmans pulmonary diseases. A bulla is a fluidfilled sac or lesion that appears when fluid is trapped under a thin layer of your skin. She had respiratory distress and non productive cough for four months.
An anatomical classification is made based on single or multiple bullae and the absence or presence of diffuse emphysema. Giant bullous emphysema vanishing lung syndrome images. This progressive condition is characterized by large bullae, usually seen in association with several forms of emphysema, and usually occurs in young men, most of whom are smokers. An important differentiating factor between these two. Bullae of lung also known by the name of giant bulla is a common pathological condition found in the lungs which is usually caused by emphysema. Giant lung bullae have a large impact on respiratory mechanics 1,2 and make ventilator management difficult in patients undergoing mechanical ventilation. Pdf nonsurgical management of giant lung bullae during.
In three of the four cases the tobacco smoking load had been relatively small, suggesting a possible causal role for marijuana in the pathogenesis of this unusual pattern of bullous emphysema. In areas of the lung completely damaged by the disease, air pockets can develop. Herein, we report a case of giant bulla of the right lung in a 35 year old woman. Successful treatment of bulla with endobronchial valves. A bulla is a permanent, airfilled space within the lung parenchyma that is at least 1 cm in size and has a thin or poorly defined wall. Treatment of giant emphysamous bulla with endobronchial. However, persistent air leakage can occur as a major complication of this surgery and can be.
Although bullous emphysema with simple or multiple bullae is a common lung pathology, few reports of giant emphysematous bullae have been described in the veterinary literature 8. Giant bullous emphysema gbe involves the presence of emphysematous areas with complete destruction of lung tissue producing an airspace bigger than 1cm in diameter. He had no other medical conditions and took no regular medications. D the giant bulla is thinwalled with fluid in the left lingular to lower lung segments. Vital signs were stable with a heart rate of 90 bpm, blood pressure of 12070 mm hg, respiratory rate of 20 breaths per minute and oxygen. Only 17 of more than 500 cases of thoracoscopic treatment of bullous lung disease over the past 3 years involved giant bullae, which included both types 1 and 4. Radiologically, bullae appear as avascular radiolucent areas with thin curvilinear walls. Bulla of the lung is a pathological entity caused by the confluence of two or more of the terminal elements of the bronchial tree. Chest radiograph shows a large lucent area in the right upper lobe with compression of the remaining lung parenchyma. The most common etiology of bullae is cigarette smoking.
The term bullous disease is reserved for multiple bullae in lungs that are otherwise normal. Chest radiograph showed a large left upper lobe bulla figure, and an. Little is known about functional results after surgical treatment. Patients with large bullae and poor respiratory function have limited treatment options. A bulla is defined as an air space in the lung measuring more than one centimeter in diameter in the distended state. A bullae is an airfilled sac that sits along the lining of the lung. Bullous and bleb diseases of the lung thoracic key. Giant bullous emphysema gbe was first described in 1937 by burke in a young male cigarette smoker with a large bullae in the upper lobe associated with paraseptal emphysema in 1937. A 44yearold man with a 17year history of tobacco and cannabis use presented to the emergency department with acute dyspnoea and leftsided pleuritic chest pain. Bullae of lung develops when the emphysema damages the lungs to an extent that air pockets develop. Bullous lung disease is characterized by the development of bullae within the lung parenchyma. Bullectomy will be necessary when bullae lead to severe dyspnea or are infected.
We report a 58yearold man who underwent surgical treatment of primary lung cancer arising from the wall of a giant bulla. The condition is usually associated with vesicular emphysema at any age and probably exists more frequently than is suspected in cases of tuberculosis, anthracosilicosis and other conditions where emphysema is often present to greater or lesser degree. Thoracoscopic technique for management of giant bullous. Giant bulla should be included in the differential diagnosis of pneumothrax. Bullous lung disease includes hivrelated emphysema. Bullae pronounced as bully is the plural word for bulla. Eligible patients included those with a giant bulla occupying onefourth or more of.
A single giant bulla may be surrounded by normal lung tissue or may be accompanied by a number of smaller adjacent bullae. Each had a history of significant exposure to marijuana. Chest roentgenography and computed tomography revealed multiple emphysematous bullae in the bilateral upper lobes, and a right upper giant bulla with a mass measuring 6 cm arising on the bulla wall. Giant bulla formation in the lung because of a checkvalve.
Giant pulmonary bullae mimicking spontaneous pneumothorax. Pdf a giant bulla of the lung mimicking tension pneumothorax. Pdf primary lung cancer arising from the wall of a giant. In this case, the patient had a giant bulla centered in the left upper lobe. Multiple giant bullae of the lung mimicking massive. Blebs and bullae may be related to an underlying disease process such as emphysema chronic obstructive pulmonary disease, but they blebs in particular may also be found in young, healthy people with no other. Case primary lung cancer arising from the wall of report a.
A single giant bulla may be present, or a giant bulla may be accompanied by a number of smaller adjacent bullae. A few investigators 1, 2 have suggested a possible association between lung cancer and pulmonary bulla. A bullectomy is a surgical procedure to remove bullaeairfilled spaces in the lungs that can compress healthy lung tissue and cause symptoms such as dyspnea shortness of breath, repeated infections, and pneumothorax lung collapse. Bullae can result from lung diseases such as chronic obstructive pulmonary disease copd, as well as lifestyle habits that affect the lungs. However, this clinical association is not well recognized. Giant bullae are large bullae occupying at least onethird of the hemithorax and surgical bullectomy is the treatment of choice. It typically occurs in young or middleaged cigarette.
Emphysematous bullae are a complication of endstage copd. In a patient with acute symptoms and no previous radiograph for comparison, this may raise a diagnostic dilemma whether it. Cect thorax confirmed giant bullae in basal portion of left lung with air fluid level seen, also present innumerable cysts of various sizes in both lungs. The giant emphysematous bulla can be an isolated large bulla with relatively well conserved lung tissue in adjacent lobes or multiply bullae in different lobes. The main cavitary pulmonary lesions are bullae, cysts, abscesses and cystic bronchiectasis 12.
All patients were males 100%, and most patients were heavy smokers with a smoking index range. Its carcinogenic correlation is not yet understood, but some peculiar clinical features are worthy of notice. Bullectomy for symptomatic or complicated giant lung bullae. Right upper lobectomy was performed, the postoperative pathological. A bulla is an aircontaining space within the lung parenchyma that arises from destruction, dilatation, and confluence of airspaces distal to terminal bronchioles and is larger than 1 cm in diameter. Giant bullous emphysema has also been called vanishing lung syndrome. Giant bullae are those that occupy at least 30% of the hemithorax.
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