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Ásgeirsson H, Lúðvíksdóttir D, Kjartanson Ó, Guðbjartsson T

A 49 year old previously healthy smoker was diagnosed with a giant bulla in his right lung, following a history of dry cough, repeated upper airway infections and increasing dyspnea for several years. Computed tomography (CT) confirmed the presence of a giant bulla in the right inferior lobe and several smaller bullae in the right superior lobe. The giant bulla was 17 cm in diameter, occupying more than half of the right hemithorax. On spirometry a moderate restrictive and a mild obstructive pattern was observed. Lung volume was measured with two different techniques, nitrogen washout and plethysmography, with volume of the bullae estimated at 2.9 L, similar to the 3.2 L determined by CT. The patient underwent thoracotomy, where the giant bulla together with the inferior lobe were removed with lobectomy and the small bullae in the superior lobe with wedge resection. Five months postoperatively the patient is in good health and is back at work. Postoperatively significant improvements in spirometry values and lung volume measurements have been documented. This case demonstrates that giant bullae can be successfully managed with surgical resection and their size can be determined by different techniques, including lung volume measurements and chest CT.

Key words: Giant bulla, diagnosis, treatment, thoracotomy, lung volume measurements

 

Correspondence: Tómas Guðbjartsson

 

Table I. Spirometry and lung volume measurements pre- and postoperatively (L and % of ref. values).

Figure 1. Chest X-ray before (1a) and 3 months after (1b) operation.

Figure 2. CT scan. The giant bulla in the right inferior lobe has a diameter of 17 cm.

Figure 3. Picture from the operation. A thin-walled giant bulla can be seen after having been opened, it was then resected by lobectomy.

Figure 4. The giant bulla after being removed.

Figure 5. Lung volume measurement with nitrogen washout. Dept. of Respiratory Medicine, Landspitali University Hospital.

Figure 6. Lung volume measurement with nitrogen washout. The area under the curve represents the nitrogen volume washed out.

Figure 7. Lung volume measurement with plethysmography. Dept. of Respiratory Medicine, Landspitali University Hospital.