DISCUSSION: Vanishing lung syndrome was described by Burke as an idiopathic syndrome of progressive dyspnea caused by extensive, predominantly upper lobe emphysema with typically asymmetrical involvement. It affects mainly young male smokers and is characterized by large bullae that occupy at least a third of a hemithorax. Bullous lung disease has been described in association with cigarette smoking, marijuana, sarcoidosis, alpha-1-anti-trypsin deficiency, Marfan syndrome and tuberculosis. High resolution CT is the most accurate means of diagnosing the condition and determining the extent of disease. CT features include extensive paraseptal emphysema coalescing into giant bullae, often compressing the normal lung parenchyma. Diagnostic evaluation includes pulmonary function testing and assessment of exercise tolerance. Treatment involves bronchodilators; video assisted thoracoscopic surgery for bullectomy is recommended for patients who have progressively enlarging bullae, worsening respiratory failure, and pneumothorax.