Médecine pulmonaire et respiratoire

A Case of a 68 Year Old Male with Bilateral Giant Bullous Emphysema: A Case Report

Abstract

Ben Victor Ubalde* and Rizalyn Piñera

Background: Bullous disorder of the lung is primarily a medical problem. A bulla is an air-filled space of 1 cm in diameter within the lung which has developed because of emphysematous destruction of the lung parenchyma. Eighty percent of patients presenting with bullae have associated pulmonary emphysema, and this entity, therefore, is referred to as bullous emphysema. A bulla that takes up a third or more of the space in and around the affected lung is called a giant bulla. Because of its close association with emphysema, giant bullae are most often found in older patients who smoke or used to smoke. The primary management of Giant bullous emphysema is often surgical. In this case, management involves the use of a minimally invasive surgery or Video Assisted Thoracoscopic Surgery (VATS). However, with decreased clinical study outcome, management results to technical difficulties.

Objective: To present and provide information on the diagnosis, management and clinical outcome of a case with bilateral Giant bullous lung disease in a 68 year old male diagnosed with emphysema.

Case synopsis: A case of an asymptomatic, physically active male diagnosed with emphysema. Initially found to have right pneumothorax. He underwent Chest tube thoracotomy on his right chest. On CT scan, he was noted to have bilateral giant bullous emphysema. He underwent Video assisted thoracoscopic surgery, right bullectomy with upper lobe segementectomy. During surgery, giant bullae of the left lung were left untouched. Post-operative course was uneventful. He was discharged in a stable condition.

Conclusion: Bullous emphysema may present with none to a severe distressing respiratory symptoms. In the event of sudden pleuritic chest pain with a history COPD, bullous emphysema should be a consideration. Avoidance of smoking prevents occurrence of COPD leading to bullous lung diseases.

Clinical recommendation: In conjunction with the decreased clinical study and absence of randomized control trial in the management and long outcome of treatment. Follow-up post discharge evaluation with accurate and adequate documentation is encouraged.