PMC6600041_01
Chest X-ray after chest drainage revealed a right PTX and bilateral bullous lesions at the lung apex.
gr1.jpg
PMC6600041_01_gr1.jpg
fig0005
Chest X-ray revealed a right PTX and bilateral bullous lesions at the lung apex (Fig. 1).
Series of patient's chest CT.
gr2.jpg
PMC6600041_01_gr2.jpg
fig0010
Chest computed tomography (CT) taken after chest drainage showed bilateral PTX and bilateral cystic changes in the lung parenchyma, predominantly in the upper lobes (Fig. 2a). However, her pulmonary lesions progressed, and the number of bullae gradually increased (Fig. 2b-c). CT showed extensive bullae in the right lobe, which exerted a mass effect on the surrounding lung parenchyma, causing a left mediastinal shift (Fig. 2d). Although she was doing well immediately after the operation, on the tenth postoperative day, she developed a tension bulla in the left lung (Fig. 2e). Chest X-ray and CT suggested return of the right bulla and mediastinal shift (Fig. 2f), and reoperation was performed. Although she experienced no additional episodes of symptomatic PTX and tension bullae, there was evidence of some residual PTX on a follow-up CT scan (Fig. 2g). During the 12-month follow-up, the pulmonary lesions also showed a tendency for improvement (Fig. 2h).
a: The thoracoscopic finding shows multiple subpleural cysts on the entire surface of the right lung. b: Apperarance of right lung LCH at emergency surgery. c: Apperarance of left lung at emergency thoracotomy.
gr3.jpg
PMC6600041_01_gr3.jpg
fig0015
Under thoracoscopic view, multiple bullous lesions were found to occupy most of the right upper and middle lobe (Fig. 3a). Emergency thoracoscopy-assisted resection of the bullae and ligation of pulmonary cysts to prevent the occurrence of PTX were performed (Fig. 3b). Emergency thoracotomy with plication of the bulla was performed (Fig. 3c).
a: Lung (Hematoxylin-eosin stain, X 20) shows a proliferation of Langerhans cells, which show elongnated kidney-shaped nuclei. Immunohistochemistry revealed CD1a and S-100 positivity. b: Repeated lung biopsy specimen showing CD1a negativity (X 10), suggestive of no active LCH.
gr4.jpg
PMC6600041_01_gr4.jpg
fig0020
Repeated lung biopsy showed no sign of active LCH (Fig. 4b).
Chest X-ray showing multinumber chest tubes due to repeated bilateral PTX.
gr5.jpg
PMC6600041_01_gr5.jpg
fig0025
She required multinumber procedures and multinumber chest tubes. (Fig. 5).