PMC6307922_01
A) preoperative chest X-Ray. Left pulmonary hyperlucency; B) preoperative chest CT. Giant emphysematous bulla with thin-walled partitions inside replacing almost the entire upper lobe; C) postoperative chest X-Ray. Complete pulmonary expansion; D) postoperative chest CT
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A 38-year-old man with longilinear shape, smoker (38 packs/year) with no other relevant medical history was referred to our department due to the finding of left pulmonary hyperlucency on a chest x-ray done (Figure 1A) because an upper airway disease. A computed tomography (CT) was performed and a giant emphysematous bulla with thin-walled partitions inside was shown, that replaced almost the entire left upper lobe (Figure 1B). He remained with pleural drainage for 13 days (Figure 1C). A postoperative spirometry and CT showed an improvement of all the volumes and carbon monoxide diffusion (FVC 6.07lts -108%, FEV1 5.31lts -116%, DLCO 9.42 - 80%) and complete pulmonary expansion (Figure 1D).
A) giant bull occupying; B) upper lobe almost replaced by the giant bulla. Healthy lower lobe; C) upper lobe was partially affected persisting a healthy parenchyma area. Black line: implantation line of the bulla; (D, E) bullectomy performed with endoscopic stapling devices; F) lung expansion of the remnant; G) interior of the bulla
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Pulmonary insufflation after resection showed a good lung expansion of the remnant (Figure 2 A-G).