PMC8349090_01
Chest computed tomography showed a giant bulla of the right upper lobe (yellow allows). It was suspected of widespread adhesion to the mediastinum of the intrathoracic by axial (a) and coronal (b) views as CT findings. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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A thoracic tube was inserted, and computed tomography revealed incomplete re-expansion right lung and giant cyst (Fig. 1).
Intraoperative findings revealed an extensively adherent thin-walled cyst (yellow allows) and a fistula (black allow) in the base of the bulla. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Lung bulla in the right upper lobe was strongly adhered to the mediastinum, and a fistula was observed at the base of the lesion (Fig. 2a). The bulla was fragile and could be torn by needle, so we folded the thin wall to make it thicker (Fig. 2b) and reinforced with a polytetrafluoroethylene (PTFE) pledget.
Schema of the operative field: the thin-wall was folded and reinforced with a pledget (a), and then this flap was sutured to the lung parenchyma with U-stitches to close the fistula (b). Air leak stopped and the bulla was inflated (c).
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First, this thickened tissue was sutured with a single U-suture (polypropylene 4-0) (Fig. 3a). Next, we added U-stitches over the PTFE pledget to close the fistula (Fig. 3b), and resulted in repairing the bulla (Fig. 3c).