A Breath from Houdini - A Case of Giant Bullous Emphysema

Overview

Journal Respir Med Case Rep

Date 2015 Jun 2

PMID 26029573

Authors

Chee Kiang Tay

Yuen Li Ng

Affiliations

Soon will be listed here.

Abstract

We describe a case of a young man presenting with exertional dyspnea. His chest radiograph showed hyperlucency in his left lung, and he was subsequently diagnosed to have giant bullous emphysema. An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed. This is followed by a literature review of the clinical presentation, natural history, radiology and management of giant bullous emphysema. Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases. This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.

References

McCormack F . Lymphangioleiomyomatosis: a clinical update. Chest. 2008; 133(2):507-16. DOI: 10.1378/chest.07-0898. View

Morgan M, STRICKLAND B . Computed tomography in the assessment of bullous lung disease. Br J Dis Chest. 1984; 78(1):10-25. View

Johnson M, Smith R, Morrison D, Laszlo G, White R . Large lung bullae in marijuana smokers. Thorax. 2000; 55(4):340-2. PMC: 1745720. DOI: 10.1136/thorax.55.4.340. View

Park H, Lim S, Park H, Park S, Kim T, Suh G . Regression of giant bullous emphysema. Intern Med. 2010; 49(1):55-7. DOI: 10.2169/internalmedicine.49.2472. View

van der Klooster J, Grootendorst A . Severe bullous emphysema associated with cocaine smoking. Thorax. 2002; 56(12):982-3. PMC: 1745972. DOI: 10.1136/thorax.56.12.982. View

Stern E, Frank M, Schmutz J, Glenny R, Schmidt R, Godwin J . Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol. 1994; 162(3):555-60. DOI: 10.2214/ajr.162.3.8109495. View

Huang W, Han R, Li L, He Y . Surgery for giant emphysematous bullae: case report and a short literature review. J Thorac Dis. 2014; 6(6):E104-7. PMC: 4073409. DOI: 10.3978/j.issn.2072-1439.2014.04.39. View

Fredenburgh L, Perrella M, Mitsialis S . The role of heme oxygenase-1 in pulmonary disease. Am J Respir Cell Mol Biol. 2006; 36(2):158-65. PMC: 2176110. DOI: 10.1165/rcmb.2006-0331TR. View

Tsao Y, Lee S . Vanishing lung syndrome. CMAJ. 2012; 184(18):E977. PMC: 3519161. DOI: 10.1503/cmaj.111507. View

10.

Nakahara K, Nakaoka K, Ohno K, Monden Y, Maeda M, Masaoka A . Functional indications for bullectomy of giant bulla. Ann Thorac Surg. 1983; 35(5):480-7. DOI: 10.1016/s0003-4975(10)60419-5. View

11.

Gunstensen J, McCORMACK R . The surgical management of bullous emphysema. J Thorac Cardiovasc Surg. 1973; 65(6):920-5. View

12.

Goldstein M, Snider G, LIBERSON M, POSKE R . Bronchogenic carcinoma and giant bullous disease. Am Rev Respir Dis. 1968; 97(6):1062-70. DOI: 10.1164/arrd.1968.97.6P1.1062. View

13.

Ayo D, Aughenbaugh G, Yi E, Hand J, Ryu J . Cystic lung disease in Birt-Hogg-Dube syndrome. Chest. 2007; 132(2):679-84. DOI: 10.1378/chest.07-0042. View

14.

Stern E, Frank M . CT of the lung in patients with pulmonary emphysema: diagnosis, quantification, and correlation with pathologic and physiologic findings. AJR Am J Roentgenol. 1994; 162(4):791-8. DOI: 10.2214/ajr.162.4.8140992. View

15.

Flenley D, Downing I, Greening A . The pathogenesis of emphysema. Bull Eur Physiopathol Respir. 1986; 22(1):245s-252s. View

16.

Sumikawa H, Johkoh T, Ichikado K, Taniguchi H, Kondoh Y, Fujimoto K . Usual interstitial pneumonia and chronic idiopathic interstitial pneumonia: analysis of CT appearance in 92 patients. Radiology. 2006; 241(1):258-66. DOI: 10.1148/radiol.2411050928. View

17.

Stern E, Webb W, Weinacker A, Muller N . Idiopathic giant bullous emphysema (vanishing lung syndrome): imaging findings in nine patients. AJR Am J Roentgenol. 1994; 162(2):279-82. DOI: 10.2214/ajr.162.2.8310909. View

18.

Miller A . The vanishing lung syndrome associated with pulmonary sarcoidosis. Br J Dis Chest. 1981; 75(2):209-14. DOI: 10.1016/0007-0971(81)90056-5. View

19.

Sharma N, Justaniah A, Kanne J, Gurney J, Mohammed T . Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 2009; 24(3):227-30. DOI: 10.1097/RTI.0b013e31819b9f2a. View

20.

Abbott G, Rosado-de-Christenson M, Franks T, Frazier A, Galvin J . From the archives of the AFIP: pulmonary Langerhans cell histiocytosis. Radiographics. 2004; 24(3):821-41. DOI: 10.1148/rg.243045005. View