Percutaneous Bullectomy in Conjunction with Endobronchial Valve Placement as an Alternative to Surgical Management of Giant Bullae

Abstract

We present the first reported case of the treatment and management of a giant bulla using percutaneous bullectomy and endobronchial valve placement. A 74-year-old woman with chronic obstructive pulmonary disease and a known large bulla in the left chest presented to the emergency department with acute-onset confusion after a traumatic fall. She was subsequently diagnosed with an intracranial hemorrhage in the distribution of the right basal ganglia. Chest imaging revealed a giant apical bulla occupying 80% of the left hemithorax. In addition, there was midline shift away from the affected side associated with volume loss in the right hemithorax and no radiographic evidence of aeration in the remainder of the left lung. Arterial blood gas analysis revealed significant hypercapnia. Surgical bullectomy was not an option, and thus, a novel approach was utilized to treat this patient.

Lung volume reduction surgery by intra-bullous fibrin sealant application using thoracoscopy, an alternative in the management of vanishing lung syndrome

“…In previous research, certain scholars have successfully utilized a combination of endobronchial valve and percutaneous pulmonary bullous puncture techniques to reduce the size of patients suffering from giant pulmonary bullae. [19,20] .…”

Bullectomy: A Waste of Space or Room for Improvement?

“…In the first study, Goud et al [8] report a case of emergency decompression of a rapidly expanding giant bulla in a ventilated patient using a combination of endobronchial valves and transthoracic needle decompression. Definitive surgical management was deemed inappropriate and very high risk, and this novel approach undoubtedly saved the life of a very sick patient.…”