Challenges in diagnosis and treatment of pneumothorax and giant bullae

Spontaneous pneumothorax is the most common acute chest disease. Often, giant bullae give the impression of the presence of air in the pleural cavity. Inadequate differential diagnosis leads to vain drainage of the pleural cavity, damage to the lung with its collapse and pneumothorax.The aim. Analyze diagnostic and tactical mistakes in patients with pulmonary emphysema, which manifests with giant bullae, and outline the ways to prevent complications.Methods. The analysis of the treatment of 1,636 patients with pulmonary emphysema and its complications undergoing treatment in the thoracic surgical department of the Samara Regional Clinical Hospital named after V.D.Seredavin in the period from 2001 to 2018 is presented.Results. Giant bulla were diagnosed in 35 (2.1%) patients, 16 of them were hospitalized ungently. In 6 patients, the diagnosis of a giant bulla of the lung was correct, and the patients were referred to the thoracic surgical department. In 10 patients, a giant bulla of the lung was regarded as pneumothorax, and pleural drainage was performed before referral to the thoracic surgical department.Conclusion. The correct interpretation of the radiological data and comparison with the clinical picture allows avoiding diagnostic errors and the associated danger and complications.

Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and righthydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.

Case Report: Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and right hydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.

PEMERIKSAAN RADIOLOGI GIANT BULLOUS LUNG DISEASE

Giant bullous lung disease adalah suatu kondisi klinis yang ditandai oleh bullae berukuran besar yang volumenya cukup signifikan. Kriteria radiologi untuk kelainan tersebut adalah adanya giant bullae di satu atau kedua apeks paru, meliputi minimal sepertiga hemithorax dan mengkompresi parenkim paru normal di sekitarnya. Pada dewasa, faktor resikonya dapat berupa kebiasaan merokok, defisiensi alfa-1 antitripsin, sedangkan pada anak dapat disebabkan kondisi idiopatik, dan late sequelae penyakit paru kronik yang terkait dengan kelahiran prematur. Giant bullae dapat terjadi akibat komplikasi dari emfisema. Pasien dengan bullae mungkin asimtomatik, namun dengan semakin membesarnya ukuran bullae, dapat menimbulkan keluhan dispneu, nyeri dada, maupun hemoptisis. Pemeriksaan radiologi untuk menegakkan diagnosis yaitu; foto thorax, ct scan thorax, ultrasonografi thorax, kedokteran nuklir dan angiografi