Bolha gigante infecciosa associada a câncer de pulmão

Abstract

A 79-year-old man sought treatment in the emergency room, complaining of a 3-month history of persistent fever, chest pain, and general fatigue. He had a smoking history of 60 pack-years and had been a heavy drinker of Japanese sake (180 mL/day) for the past thirty years. Laboratory test results indicated severe inflammation, and a chest X-ray showed a giant bulla with a diameter of 24 cm in the left lung ( Figure 1a). By his own account, he had no history of abnormalities on X-rays, and his latest medical check-up, conducted in the preceding year, had IntroductionMany aspects of giant bullae remain unknown. In addition, guidelines for the management of infectious giant bullae have yet to be established. In general, antibiotic therapy alone is insufficient to treat infectious giant bullae. Although surgical treatment is often recommended for patients with this condition, many such patients are not candidates for surgery because of poor general health status and high-risk factors. Here, we present a case of infectious giant bulla that rapidly increased in size. AbstractA 79 year-old man sought treatment in the emergency room complaining of persistent fever, chest pain, and general fatigue. A chest X-ray showed a giant infectious bulla (24 cm in diameter) in the left lung. The patient had no history of abnormalities on X-rays, and his latest medical check-up, conducted in the preceding year, had produced no abnormal findings. Diagnostic procedures, including bronchoscopy, revealed lung cancer (large cell carcinoma) in the left lower bronchus. The tumor obstructed the airway. Although there have been various reports of giant bullae, their etiology remains unknown. We suggest that an obstruction, such as that caused by the tumor in this case, can lead to air trapping, resulting in the formation of a bulla. In the case of a giant bulla that rapidly increases in size, lung cancer should be included in the differential diagnosis.Keywords: Lung neoplasms/complications; Infection; Drainage. ResumoUm homem de 79 anos procurou tratamento no pronto-socorro com queixas de febre persistente, dor torácica e fadiga geral. A radiografia de tórax mostrou uma bolha gigante infecciosa (24 cm de diâmetro) no pulmão esquerdo. O paciente não tinha histórico de anormalidades em radiografias, e seu ultimo check-up médico no ano anterior não revelou anormalidades. Os procedimentos diagnósticos, incluindo broncoscopia, revelaram câncer de pulmão (carcinoma de pulmão de células grandes) no brônquio inferior esquerdo. O tumor obstruía a via aérea. Apesar de vários relatos de bolhas gigantes, a sua etiologia ainda é desconhecida. Nós sugerimos que uma obstrução, como a causada pelo tumor neste caso, pode causar aprisionamento aéreo, resultando na formação de uma bolha. No caso de uma bolha gigante que cresce rapidamente de tamanho, o câncer de pulmão deve ser incluído no diagnóstico diferencial.