-
Views
-
Cite
Cite
Palashkumar Jaiswal, Jayakumar Sreenivasan, Radhika Jaiswal, Aman Kugasia, Kathryn A Radigan, Anupam Basu, The vanishing lung, Postgraduate Medical Journal, Volume 93, Issue 1106, December 2017, Pages 780–781, https://doi.org/10.1136/postgradmedj-2017-134824
Close - Share Icon Share
Extract
Case report
A 48-year-old woman with medical history significant for 20 pack-years of smoking presented with decreased exercise tolerance for the last year. On examination, her respiratory rate was 18 and oxygen saturation was 96% on room air with absent breath sounds within the left lung field. Alpha-1 antitrypsin levels were normal. Chest radiograph revealed giant emphysematous bulla with concern for concurrent pneumothorax (figure 1). CT scan of the chest revealed a massive bulla without a ‘double wall sign’ making superimposed pneumothorax unlikely (figure 2). Chest tube insertion was deferred and patient underwent bullectomy. Prior to surgery, her exercise tolerance was 1–2 blocks which improved to 7–8 blocks 2 months postsurgery.
...
...
Discussion
Giant bullous emphysema or vanishing lung syndrome (VLS) is defined as a large bulla occupying at least one-third of hemithorax leading to displacement of adjacent lung tissue. VLS is often complicated by spontaneous pneumothorax. Distinguishing uncomplicated VLS from one with superimposed pneumothorax may be challenging on radiograph,1 and CT scan evaluation is often necessary. Double wall sign, classically seen with VLS complicated by pneumothorax, is established when air is present on both sides of the bulla wall in parallel to the chest wall.2 In the absence of this sign, pneumothorax is unlikely. In its presence, patient should be stabilised with drainage of pleural air with a planned intervention. Surgery for VLS is indicated on a preventive basis if the size of bulla increases on follow-up, if reduced exercise tolerance is refractory to medical therapy or in VLS complicated by pneumothorax, bleeding or infection.3
