Percutaneous drainage of a fluid-containing emphysematous bulla

We present the case of a 38-year-old man, with congenital bullous emphysema, who presented with unilateral pleuritic chest pain, rigors and a non-productive cough. A chest X-ray on admission demonstrated extensive bilateral bullous lung disease with left-sided lung collapse. There were fluid levels present within several bullae, with the largest bulla compromising most of the posterior aspect of the left lung base. We suspected infected emphysematous bullae. Despite prolonged conservative management with antibiotics the patient deteriorated clinically, consistently spiking temperatures and desaturating. Repeat imaging demonstrated further accumulation of fluid in the largest bulla. A small bore chest drain was inserted into this bulla under ultrasound guidance, draining 550 mL of pulmonary fluid. The patient stabilised clinically and was discharged. He remained well after completing six weeks of intravenous antibiotics in the community.

Anesthetic management for resection of a giant emphysematous bulla: a case report

Anesthetic management for patients with a giant emphysematous bulla (GEB) is challenging. This case report describes a patient who developed 95% pulmonary compression by a GEB. A 14-Ga indwelling catheter was placed in the GEB before surgery to allow for slow re-expansion of the collapsed lung tissue. This prevented rupture of the GEB during anesthesia. Additionally, positive-pressure ventilation was performed to reduce the risk of re-expansion pulmonary edema. This respiratory management strategy may be beneficial for patients with a GEB who develop pulmonary dysfunction during thoracic surgery.

A Pilot Study on Plasma Iipidomic Profile of Giant Pulmonary Bulla

Background: The symptom of chronic obstructive pulmonary disease (COPD) and giant pulmonary bulla (GPB) also called giant emphysematous bulla (GEB) is too similar to distinguish, and the treatment of the two diseases are completely different because of the different pathology. We investigated the plasma lipid profiles from patients of COPD and GPB to find targeted lipid changes responsible for differentiation between two diseases.Methods: Plasma was collected from 9 patients with COPD, and 10 patients with COPD and GPB. Extracted lipids were analyzed using high performance liquid chromatography-triple quadrupole mass spectrometry (HPLC-QqQ-MS) to characterize lipid profiles. Principal components analysis (PCA), orthogonal projection to latent structures-discriminant analysis (OPLS-DA) and variable importance in projection (VIP) scores were used to estimate the importance of each lipid variable.Results: The HPLC-QqQ-MS method identified 582 kinds of lipids at negative mode, and 577 kinds of lipids at positive mode. Lipid profiles were significantly different between COPD and GPB. Principal discriminant phospholipids between COPD and GPB were LPC(16:1)+AcO, LPC(16:0)+AcO, LPC(18:2)+AcO, LPC(18:1)+AcO, PC(16:0/22:5)+AcO, PC(18:2/18:2)+AcO, LPE(18:0)-H, LPE(16:0)-H, LPE(18:2)-H, PE(18:1/18:2)-H and FFA(24:0)(GPB group were significantly decreased compared to COPD group, VIP>1 and P<0.05).Conclusions: Our study provides insights into the alteration of the plasma lipid profile of GPB patients, commonly resulting from COPD, that may lead to improved GPB treatment and differentiation of this disease from COPD. Furthermore, LPC (16:0) +AcO was found to have a high potential to be a possible biomarker to distinguish the two diseases.

Lung carcinoma within a lung bulla wall: literature review and case report

Pulmonary emphysema is a common pulmonary disease encountered in daily medical practice. Its management follows specific guidelines but lacks standardized screening for the development of lung cancer. The precancerous theory of emphysematous bulla/cyst is not well described in the literature, with only a few reports of malignancy within an emphysematous bulla wall. We report the case of a 46-year-old man with productive cough and hemoptysis. A chest radiograph showed multiple irregular radiolucencies in both lung apices. Computed tomography revealed bilateral emphysema with a left apical emphysematous bulla that showed a thickened wall and accumulation of fluid within the bullous cavity. Due to life-threatening hemoptysis, a left upper lobectomy and mediastinal lymph node sampling were performed. The pathology report showed pleomorphic carcinoma within the emphysematous cystic wall. Postoperative computed tomography of the abdomen and pelvis showed focal thickening in the left adrenal gland, and adrenal metastatic carcinoma was confirmed. Brain magnetic resonance imaging also showed metastasis. The patient was started on chemotherapy. He died 2 years postoperatively. Twenty-three cases have been reported from 1989 to 2016, but there was no case of metastatic disease within the wall of an emphysematous bulla. Lung emphysema is not routinely screened for cancer development because it is not cost-effective and does not seem to improve patient outcome, but should this practice be reviewed?