DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20163970

A rare case of vanishing lung syndrome with pneumothorax: importance of computed tomography

Pradosh Kumar Sarangi, Sanjay Kumar Nahak, Sasmita Parida, Jayashree Mohanty

Abstract


Vanishing lung syndrome (VLS), also known as giant bullous emphysema (GBE) is a distinct clinical syndrome usually affecting young male smokers characterised by large bullae that involve at least one-third of one or both hemithoraces. We are reporting one such case in a 40-year-old male patient, who was a chronic smoker for past 20 years. He was diagnosed having chronic obstructive pulmonary disease (COPD) on the basis of his history and chest X-ray findings 5 years back and treated symptomatically. He was never suspected of having VLS until a computed tomography of thorax done in our department revealed characteristic findings of VLS with pneumothorax and subcutaneous emphysema. Bullectomy, either via video thoracoscopy or conventional thoracotomy, is the treatment of choice. The patient is now in follow-up with pulmonary medicine department. This case exemplifies role of HRCT thorax in timely diagnosis and planning appropriate treatment of VLS.


Keywords


Vanishing lung syndrome, Bulla, emphysema, Video-assisted thoracoscopic surgery, Computed tomography

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References


Burke R. Vanishing lungs: a case report of bullous emphysema. Radiology. 1937;28:367-71.

Roberts L, Putman CE, Chen JTT, Goodman LR, Ravin CE. Vanishing lung syndrome: upper lobe bullous pneumopathy. Rev Interam Radiol. 1987;12:249-55.

Hii SW, Tam JDC, Thompson BR, Naughton MT. Bullous lung disease due to marijuana. Respirology. 2008;13:122-27.

Beshay M, Kaiser H, Niedhart D, Reymond MA, Schmid RA. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur J Cardio-thoracic Surg. 2007;32:834-8.

Hutchison DCS, Cooper D. Alpha-I-antitrypsin deficiency:smoking, decline in lung function and implications for therapeutictrials. Respiratory Medicine. 2002;96:872-80.

MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:18-31.

Morgan M, Strickland B. Computed tomography in the assessment of bullous lung disease. Br J Dis Chest. 1984;78:10–25.

Vij AS, James R, Singh A, Dhaliwal AS, Chhabra A, Vij KK. A Rare Case of Vanishing Lung Syndrome. J Assoc Physicians India. 2014;62(12):51-3.

Tay CK, Ng YL. A breath from Houdini - A case of giant bullous emphysema. Respir Med Case Rep. 2014;14:30-3.

Sharma N, Justaniah AM, Kanne JP, Gurney JW, Mohammed TL. Vanishing lung syndrome(giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 2009;24:227-30.

Stern EJ, Webb WR, Weinacker A, Müller NL. Idiopathic giant bullous emphysema (vanishing lung syndrome): imaging findings in nine patients. AJR Am J Roentgenol. 1994;162:279-82.

Gayle M, Waitches GM, Stern EJ, Dubinsky TJ. Usefulness of Double-wall sign in Detecting Pneumothorax in Patients with Giant Bullous Emphysema. AJR. 2000;174:1765-8.

Shah NN, Bhargava R, Ahmed Z, Pandey DK, Shameem M, Bachh AA, et al. Unilateral bullous emphysema of the lung. Lung India. 2007;24:30-2.

Palla A, Desideri M, Rossi G, Bardi G, Mazzantini D, Mussi A, et al. Elective surgery for giant bullous emphysema: a 5 year clinical and functional follow-up. Chest. 2005;128:2043-50.

Huang W, Han R, Li L, He Y. Surgery for giant emphysematous bullae: case report and a short literature review. J Thorac Dis. 2014;6:104-7.

Schipper PH, Meyers BF, Battafarano RJ, Guthrie TJ, Patterson GA, Cooper JD. Outcomes after resection of giant emphysematous bullae. AnnThorac Surg. 2004;78:976-82.