A Case of Bilateral Giant Bullae in Young Adult
A 35-year-old man was referred to our clinic for an abnormal radiographic finding detected in screening chest X-ray. He was a current smoker with 30 pack-year and suffered from dyspnea on exertion (New York Heart Association functional class II). His chest radiography showed bilateral giant bullae occupying almost the entire left hemithorax and a third of right thorax (). The remaining part of the left lung was small and was compressed to the mediastinum. Pulmonary function tests revealed the following: forced vital capacity (FVC), 2.54 L (51% of predicted); forced expiratory volume in one second (FEV1), 1.57 L (40% of predicted); FEV1/FVC ratio, 0.63; diffusion capacity of the lung for carbon monoxide (DLCO), 17.4 mL/mm Hg/min (73% of predicted), and DLCO/alveolar volume (VA), 5.13 [mL/mm Hg/min]/L (114% of predicted). According to chest radiograph, giant bullae occupying nearly the entire left hemithorax with compressive atelectasis to the left lung, with the risk of impending pneumothorax. Considering limitation of his exercise capacity, elective surgical bullectomy by video-assisted thoracoscopic surgery (VATS) was performed. A left-sided, three-port technique was used to gain success to the thoracic cavity. About 28-cm-sized giant bulla originating from the apex of the left upper lobe was identified. In the surgical field, multiple bullae were detected simultaneously appeared at basal segment of the left lower lobe and the left lower lobe presented with complete atelectasis (). Wedge resections were performed for an giant bulla at left upper lobe apex and bullae in left lower lobe basal segment using endoscopic stapling devices (Endo GIA 60). After surgical removal of bullae, one chest-tube was inserted and the collapsed left lung was re-expanded (). The patient was completely recovered without any event and was discharged. He remained well at the time of 1month after surgery ().