Surgical pathology of bullae with and without pneumothorax

Abstract

Experience with 2030 patients admitted for an actual episode of spontaneous pneumothorax, and with 370 patients hospitalized for bullous emphysema is thoroughly analyzed. Out of these groups, 400 patients (318 and 82 respectively) underwent an open thoracotomy. Macroscopic operative findings were divided into 8 groups. Descriptions of the aspect, size and site of bullae, respiratory function, mortality and follow-up data, are presented. Pathogenesis of the localised apical disease in comparison to the extended and diffuse types is outlined. Attention is drawn to the high operative risk in generalized emphysema and airway obstruction when associated with tension bullae and/or pneumothorax. More than 30% of the patients could not be included in either the juvenile type, isolated apical disease, or in the category of bullae associated with generalized emphysema. Reasons for an early rupture of apical subpleural blebs and the high resistance to check valve pressure of bullae following alveolar disruption are discussed. The observations lead to the conclusion that surgical pathology and treatment problems in bullous emphysema and in spontaneous pneumothorax have a lot in common and their arbitrary separation is not justified.

Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients

“…This rupture causes air to dissect along the pulmonary vasculature towards the hilum. The gas then dissects centrally along the bronchoalveolar trunks, the peribronchial space or within the lymphatics to reach the mediastinum [6]. Data from animal experiments indicate that the intrapulmonary pressure, the alveolar -arterial pressure gradient, the degree of alveolar expansion, as well as the presence of pulmonary parenchymal pathology plays prominent roles in alveolar rupture [5].…”

Results of the surgical treatment of pulmonary bleb and bullous disease

“…Sudden and severe dyspnea should raise the suspicion for the pneumothorax because of a ruptured bullae which occurs mostly in the context of underlying emphysema. [ 7 23 24 25 ] Our study showed that the most common clinical presentation was respiratory distress, in which case the patients had been under surgical resection with a complete recovery over a month.…”

Surgical resection for bilateral giant emphysematous bullae

“…Therefore, the airway pressure should be carefully kept in lower level during the surgery. In this case, the possible mechanism of the increasing size of contralaretal giant bulla was assumed that air introduced into the bulla by positive pressure ventilation was not drainaged because of a one-way valve mechanism [7]. Since the compression of a mediastinum and a functional lung worsened hemodynamic status, urgent decompression of the bulla was required and bullectomy on the right side was performed immediately.…”