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

Abstract

<p align="left">Vanishing lung syndrome (VLS), also known as giant bullous emphysema (GBE) is a distinct clinical syndrome usually affecting young male smokers characterised by large bullae that involve at least one-third of one or both hemithoraces. We are reporting one such case in a 40-year-old male patient, who was a chronic smoker for past 20 years. He was diagnosed having chronic obstructive pulmonary disease (COPD) on the basis of his history and chest X-ray findings 5 years back and treated symptomatically. He was never suspected of having VLS until a computed tomography of thorax done in our department revealed characteristic findings of VLS with pneumothorax and subcutaneous emphysema. Bullectomy, either via video thoracoscopy or conventional thoracotomy, is the treatment of choice. The patient is now in follow-up with pulmonary medicine department. This case exemplifies role of HRCT thorax in timely diagnosis and planning appropriate treatment of VLS.</p>

Look before you leap: a curious case of giant pulmonary bulla

“…CT scan excluded pulmonary embolism and demonstrated a large lucency on the right hemithorax together with bilateral chronic emphysematous changes (figure 2) and basal opacities suggestive of aspiration. There were no signs suggestive of accompanying pneumothorax such as air outlining both sides of the bulla wall parallel to the chest wall (known as the ‘double wall sign’) 1. The patient’s clinical status improved with supplemental oxygen and intravenous antibiotic therapy.…”

Case report: A bulla mistaken for a pneumothorax

“…It has also been reported in young male thin smokers and there are numerous case reports that have added to the body of evidence. [1][2][3][4][5][6][7][8] There are also case reports of the giant bulla being misinterpreted for a pneumothorax. [1][2][3]6,10] Vanishing lung syndrome is characterised by a slowly enlarging upper lobe bulla that compresses normal lung parenchyma and causes mediastinal shift, with the patients experiencing increasing dyspnoea and reduced exercise tolerance.…”

“…[9] Patients with more widespread disease have limited treatment options. [4] Computer tomography is the gold standard for distinguishing between a pneumothorax and a giant bulla [2,3,5] as insertion of a chest drain into a bulla leads to significant morbidity and mortality from prolonged air leaks. [9][10] Case Report A 61 year old male presented to Accident and Emergency with a gradual onset of a four day history of increasing breathlessness.There was no cough, chest pain or sputum produced.…”

“…Locally, the British Society guidelines are followed and they would advocate admission, controlled oxygen therapy and observation or intervention depending on the size of the pneumothorax and symptoms of the patient. [12] Options for management of bullae are smoking cessation, observation only if asymptomatic, endobronchial valves or bullectomy, or this case potentially a pneumonectomy and in appropriate cases lung transplantation [1][2][3][4][5][6][7][8][9] The main learning point from this case is that bullae and pneumothorax can have very similar appearances on chest radiographs. It was only by chance that this patient did not have a chest drain inserted.…”

Please do not put a chest drain in my chest! Vanishing lung syndrome

“…Vanishing lung syndrome, also known as giant bullous emphysema is a condition usually reported in older smokers with advanced chronic obstructive lung disease. It has also been reported in young male thin smokers and there are numerous case reports that have added to the body of evidence [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. There are also case reports of the giant bulla being misinterpreted for a pneumothorax [ [1] , [2] , [3] , 6 , 10 ].…”