Obstructive Lung Diseases |

Emphysematous Bulla-Causing Dyspnea Due to Cardiac Compression: A Novel Presentation and Successful Surgical Resection With Complete Relief of Symptoms FREE TO VIEW

B. Jakub Wilhelm, MD; Aniket Sakharpe, MD; Leopoldo Baccaro, MD; Stanley Ogu, MD; Richard Angelico, MD
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Easton Hospital, Drexel University, College of Medicine, Easton, PA

Chest. 2014;145(3_MeetingAbstracts):351A. doi:10.1378/chest.1823857
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SESSION TITLE: COPD Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: A giant bulla is defined as an air space in the lung that occupies at least 30% of the hemithorax. Indications for surgical resection are controversial but most commonly include dypnea due to compression of adjacent lung tissue or spontaneous pneumothorax. Previous authors have suggested including mediastinal shift as an indication, but outcome data is lacking. We present a unique case of a 71-year-old patient with bullous emphysema which resulted in compression of the dextrocardial structures.

CASE PRESENTATION: A 71-year-old male patient initially presented with a spontaneous pneumothorax causing sudden cardiorespiratory dystress. A chest tube was placed and despite successful resolution of the pneumothorax, the patient’s dypnea and tachycardia persisted. An echocardiogram and a computed tomography of the chest revealed a giant right upper lobe bulla causing right ventricular compression. Surgical resection of the giant bulla resulted in the alleviation of symptoms.

DISCUSSION: Various clinical presentations of patients with emphysematous bullae have been described in the literature. These have included bleeding, infection, pneumothorax, large bullae mimicking pneumothorax and severe space occupation of adjacent lung tissue with subsequent dyspnea. Mediastinal shift with cardiac compression is extremely rare. Indications for surgical therapy of bullous emphysema remain controversial. In our case, surgical resection of the bulla relieved the patient’s symptoms and he returned to his regular daily activities. This is a unique presentation of bullous emphysema. We encountered only one similar case reported in the English and German literature. Mediastinal shift has been considered an indication for surgical resection of emphysematous bullae, but information about the outcome of such interventions is limited.

CONCLUSIONS: Surgical resection of giant emphysematous bullae can improve symptoms significantly. Indications for surgery should be individualized with a focus on clinical symptoms and the anatomy of the bulla. Operative resection of emphysematous bullae causing symptomatic mediastinal shifts with cardiac compression should be considered as a treatment.

Reference #1: Palla, A, Desideri, M, Rossi, G, et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest 2005; 128:2043-2050.

Reference #2: Verma, RK, Nishiki, M, Mukai, M, et al. Intracavitary drainage procedure for giant bullae in compromised patients. Hiroshima journal of medical sciences 1991; 40:115-118.

Reference #3: Schipper, PH, Meyers, BF, Battafarano, RJ, et al. Outcomes after resection of giant emphysematous bullae. The Annals of thoracic surgery 2004; 78:976-82; discussion 976-82.

DISCLOSURE: The following authors have nothing to disclose: B. Jakub Wilhelm, Aniket Sakharpe, Leopoldo Baccaro, Stanley Ogu, Richard Angelico

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