PMC7105355_01
(A-C) High resolution computed tomography (HRCT) taken before the procedure (Horizontal axis, coronal, sagittal, respectively) indicates severe emphysema and a giant bulla in the right middle lobe. (D-F) HRCT taken at 1st day after the procedure showing the decrease of the bulla and the re-expansion of the adjacent lobe.
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It revealed severe bilateral centrilobular emphysema with a giant bulla, which might be located in the right middle lobe (RML) (see in Figure 1A-C). HRCT conducted on the 1st day illustrated mild shrinking of the giant bulla and re-expansion of the adjacent lobe (see in Figure 1D-F).
(A) 3-D analysis by SYNAPSE shows the lung lobes with a different color: yellow, right upper lobe; blue, right middle lobe; green, right lower lobe; red, left upper lobe; purple, left lower lobe. (B) 3-D analysis by the SYNAPSE shows the emphysematous area. The larger the area, the more severe the emphysema.
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Table 1 and Figure 2A and B).
The output in the Chartis system. (A) Right middle lobe: Higher leak airflow before blocking in the right middle bronchus. The airflow stops immediately and a progressive negative pressure is observed. (B) Right upper lobe: Small leak airflow (less than 50mL/min) before blocking in the right upper bronchus. And the airflow gradually decreases and reaches zero in 3min and 1s.
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We blocked the right middle bronchus with the balloon catheter and observed the expiratory airflow and the airway pressure (Figure 3A). Then we placed the catheter in the entrance of the right upper bronchus, a peak airflow less than 50 mL/min was measured before blocking and then a gradual decrease in flow (total of 22.4mL) and an increase in pressure were observed (Figure 3B).
(A) Posterior-anterior chest X-ray taken before the procedure indicating severe emphysema and a huge bulla in the right lung. (B) Supine chest X-ray taken after the procedure, showing a mild volume decrease in the right upper lobe.
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It showed that the right lung volume decreased mildly compared to that before the procedure (Figure 4A and B).