Vanishing Lung Syndrome: A Rare Entity

Abstract

Vanishing lung syndrome is characterised by giant bullae that compress the underlying lung. Differentiating between bullous emphysema and pneumothorax and choosing the right treatment modality can be challenging. The present report describes a case of a giant pulmonary bulla in a young male patient. A 20-year-old male was admitted with complaints of shortness of breath, chest pain, sweating, and tachycardia. Chest X-ray and chest CT images revealed the presence of giant bullae occupying the left hemithorax and pneumothorax. A chest tube was inserted percutaneously under local anesthesia into the pleural cavity and then we performed bullectomy using thoracoscopic surgery. Residual lung re-expansion yielded good postoperative results without complications. It can be very difficult to distinguish a pneumothorax from a giant bulla and preoperative assessment of the extent and distribution of the bullae is vital for the following procedures.

Keyword: Giant Bulla; Pulmonary Emphysema; Pneumothorax.

Keywords

• -

Journal of Turgut Ozal Medical Center

Öz

Vanishing lung sendrom nadir görülen ve dev bül veya büllerin akciğerin büyük oranda kollapsına neden olduğu bir antitedir. Bu çalışmada solunum sıkıntısı, terleme, çarpıntı şikayeti ile acil servise başvuran 20 yaşında, radyografik olarak sağ hemitoraksın tümünü kaplayan dev bül ve çevresinde pnömotoraks saptanan bir erkek hasta sunuldu. Hastaya tüp torakostomi uygulandı ve daha sonra torakoskopik cerrahi ile bül eksizyonu yapıldı. Postoperatif dönemde komplikasyon gelişmedi. Akciğer ekspanse olan olgu postop 6. günü şifa ile externe edildi. Vanishing lung sendromunda en önemli sıkıntı bül, pnömotoraks ayrımının yapılmasında ve altta yatan akciğer parankiminin ne derece sağlıklı olduğunun değerlendirilmesinde yaşanılan zorluktur. Uygun vakalarda bül eksizyonu ile kollabe akciğerin ekspanse olur ve tam bir klinik düzelme sağlanır

Anahtar Kelimeler

• Dev Bül, Pulmoner Amfizem, Pnömotoraks

Kaynakça

1. Mehran RJ, Deslauriers J. ındications for surgery and patient work-up for bullectomy. Chest Surg Clin North Am 1995;5:717-34.
2. Stern EJ, Webb WR, Weinacker A, Müller NL. Idiopathic giant bullous emphysema (vanishing lung syndrome): Imaging findings in nine patients. AJR 1994;162:279-82.
3. Waseem M, Jones J, Brutus S, Munyak J, Kapoor R, Gernsheimer J. Giant bulla mimicking pneumothorax. J Emerg Med 2005;29:155-8.
4. Khasawneh FA, Nakhla EN, Karim A, Halloush RA. Vanishing lung syndrome mistaken for bilateral spontaneous pneumothorax. BMJ Case Rep 2013.
5. Tsao YT, Lee SW. Vanishing lung syndrome. CMAJ 2012;184:e977.
6. Wang J, Liu W. Vanishing lung syndrome. Can Respir J 2014;21:8.
7. Van Bael K, La Meir M, Vanoverbeke H. Video-assisted thoracoscopic resection of a giant bulla in vanishing lung syndrome:case report and a short literature review. J Cardiothorac Surg 2014;9:4.
8. Liang JJ, Wigle DA, Midthun DE. Vanishing lung syndrome (Idiopathic giant bullous emphysema). Am J Med Sci 2013. (Epub ahead of print).

9. Darlong LM, Hajong R, Das R, Topno N. Vanishing lung syndrome. Indian J Surg 2010;72:75-6.
10. Sharma N, Justaniah AM, Kanne JP, Gurney JW, Mohammed TH. Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging 2009;24:227-30.
11. Waitches GM, Stern EJ, Dubinsky TJ. Usefulness of the double-wall sign in detecting pneumothorax in patients with giant bullous emphysema. AJR 2000;174:1765-8.
12. Chen CK, Cheng HK, Chang WH, Lai YC, Su YJ. Giant emphysematous bulla mimicking tension pneumothorax. Am J Med Sci 2009;337:5.
13. Findlay JM, Keogh MJ, Taghavi FJ, Sayeed RA. Radiological presentation of a giant bulla as tension pneumothorax. J Emerg Med 2012;43:e211-3.