A breath from Houdini – A case of giant bullous emphysema

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.

Vanishing Lung Syndrome with Community-Acquired Pneumonia and Infection of Bullae

“…The natural history of vanishing lung syndrome is reported to be a progressive one, but the rate of it is highly variable [8]. Bullae can enlarge, compressing healthy lung parenchyma and interfering with normal respiratory mechanics and gas exchange (increase in dead space fraction).…”

Enfisema bolhoso gigante idiopático em paciente jovem: Relato de caso/ Idiopathic giant bullous emphysema in a young patient: a case report

“…Mortalidade aumentada ficou atribuída a fatores intrínsecos dos pacientes, como história prévia de enfisema difuso. O mesmo estudo ainda mostra que no período avaliado o procedimento foi capaz de melhorar sintomas, função pulmonar e não houve formação de novas bolhas no local da cirurgia 7 .…”

A rare case of vanishing lung syndrome with pneumothorax: importance of computed tomography

“…intravenous methylphenidate, cocaine and marijuana) have been described. 9 Chest radiography is the most practical method for identifying the presence of bullae and their progression. However in the clinical setting of acute dyspnoea presenting to emergency department in undiagnosed giant bullous emphysema, a chest radiograph may not be reliable enough to differentiate a pneumothorax from a giant bulla.…”

“…Hence in case of equivocal clinical and conventional radiographic findings, emergency CT is advocated. 6,9,12,13 Recognising the double wall sign on HRCT help distinguish a pneumothorax from adjacent giant bulla in the setting of giant bullous emphysema. This sign occurs when one sees air outlining both sides of the bulla wall parallel to the chest wall (the intrathoracic equivalent of the double-wall sign of pneumoperitoneum).…”

“…The indications include (1) spontaneous pneumothorax, (2) infection, (3) dyspnoea or (4) increasing bulla size. 9,10,[14][15][16] Determination of the preoperative bulla volume allows the prediction of the expected increase of postoperative FEV1. There is significant improvement in all three measurements of FVC, FEV, and dyspnoea grading in the early postoperative period but all the improvements except FVC are insignificant at five to ten years.…”