SESSION TITLE: Bronchology Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Huge bullae may compress lungs leading to ventilation decrease. Sometimes that is lethal to COPD patients with huge bullae. Conventional surgery is useful for the treatment of huge bullae. However, some patients could not endure that. Bronchial occlusion with occluder devices under bronchoscopy may be alternative to huge bullae treatment.
CASE PRESENTATION: A 64-year-old man presented with cough and sputum for 34 years, dyspnea for 5 years, exacerbation with oedema legs for 3 weeks. A chest CT demonstrated COPD features and two huge bullae. The bulla in the right upper lobe was 4X12X6cm, the bulla in the lower lobe was 12X10X10cm. Functional lung in the middle and lower lobes were almost not seen. Except for routine therapies on AECOPD and respiratory failure, closed drainage of the bulla in the right lower lobe was down. The bulla became much smaller rapidly and dyspnea relieved, but air leakage persisted. 300ml autoblood were injected into the bulla on the 12th day after drainage trying to stop air leakage, but it failed. On the thirtieth day, an occluder device made of nickel titanium alloy and polytetrafluoroethylene membrane was inserted to the bronchus of lateral basal segment in right lower lobe. Eight days later, air leakage stoped and the drainage was removed. Since then, the patient developed exacerbation 2-3 times every year, routine therapies of AECOPD were carried out repeatedly. Chest CT at 1 and 2 years after occluder device insertion showed atelectasis of the lateral basal segment, the middle lobe and other basal segment expanded. The patient died of severe pneumonia of both lower lobes 28 months later. The last CT showed bronchiectasis in the post basal segment of rigte lower lobe.
DISCUSSION: Bullae are common in COPD patients. Small bullae have less impact on pulmonary function. Huge bullae were harmful and sometimes may be lethal to the patients. Conventional surgery is not tolerated by all patients with huge bullae. Our report suggested that bronchial occlusion combined with closed drainage and autoblood injection into bullae might be a useful strategy. But the affection of occluder divices to the drainage ot adjacent bronchi should be considered.
CONCLUSIONS: Bonchial occlusion combined with closed drainage and autoblood injection into bullae might be an alternative for the treatment of huge bullae. But the affection of occluder divices to adjacent bronchi should be considered.
Reference #1: Gunnarsson SI, Johannesson KB, Gudjonsdottir M, et al. Incidence and outcomes of surgical resection for giant pulmonary bullae--a population-based study. Scand J Surg. 2012;101(3):166-9.
DISCLOSURE: Jianlinhu Hu: University grant monies: employment
This report was granted by clinic innovation fund of the military medical university /2009XLC14