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A breath from Houdini - A case of giant bullous emphysema.

Tay CK, Ng YL - Respir Med Case Rep (2014)

Bottom Line: An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed.Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases.This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

ABSTRACT
We describe a case of a young man presenting with exertional dyspnea. His chest radiograph showed hyperlucency in his left lung, and he was subsequently diagnosed to have giant bullous emphysema. An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed. This is followed by a literature review of the clinical presentation, natural history, radiology and management of giant bullous emphysema. Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases. This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.

No MeSH data available.


Related in: MedlinePlus

CT chest – large bullae in both left upper and lower lobes, with co-existing bronchiectasis (thin arrow) and cysts (bold arrow).
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fig2: CT chest – large bullae in both left upper and lower lobes, with co-existing bronchiectasis (thin arrow) and cysts (bold arrow).

Mentions: He remained well until 2010 when he began to feel breathless on exertion. This was not associated with chest pain, orthopnea, paroxysmal nocturnal dyspnea or lower limb swelling. He denied any significant cough, hemoptysis or wheezing. He did not have constitutional symptoms such as fever, night sweats, anorexia or weight loss. He also did not have any skin or joint complaints. A repeat chest radiograph at this juncture (Fig. 1) revealed increased lucency in the upper half of the left hemithorax. This was followed by a chest computed tomography (CT) scan that revealed bronchiectatic changes in the left lower lobe with a few small cysts and several bullae occupying almost the entire left hemithorax (Fig. 2). Extensive blood investigations including immunoglobulin levels, connective tissue disease screen and alpha-1 antitrypsin level were unremarkable. Spirometry showed a forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio of 0.83, FVC of 2.56 L (59% of predicted), and FEV1 of 2.13 L (59% or predicted). Bronchodilator reversibility testing was not performed. Total lung capacity (TLC) measured via nitrogen washout method and body plethysmography showed an unsurprising discrepancy in results; TLC measured 3.43 L (56% of predicted) and 5.33 L (88% of predicted) respectively. However, the residual volume of 2.65 L (156% of predicted) suggested the presence of significant air trapping, making dynamic hyperinflation the most probable physiological explanation for the patient's breathlessness. Carbon monoxide diffusion capacity, adjusted for hemoglobin was unremarkable at 77% of predicted.


A breath from Houdini - A case of giant bullous emphysema.

Tay CK, Ng YL - Respir Med Case Rep (2014)

CT chest – large bullae in both left upper and lower lobes, with co-existing bronchiectasis (thin arrow) and cysts (bold arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356045&req=5

fig2: CT chest – large bullae in both left upper and lower lobes, with co-existing bronchiectasis (thin arrow) and cysts (bold arrow).
Mentions: He remained well until 2010 when he began to feel breathless on exertion. This was not associated with chest pain, orthopnea, paroxysmal nocturnal dyspnea or lower limb swelling. He denied any significant cough, hemoptysis or wheezing. He did not have constitutional symptoms such as fever, night sweats, anorexia or weight loss. He also did not have any skin or joint complaints. A repeat chest radiograph at this juncture (Fig. 1) revealed increased lucency in the upper half of the left hemithorax. This was followed by a chest computed tomography (CT) scan that revealed bronchiectatic changes in the left lower lobe with a few small cysts and several bullae occupying almost the entire left hemithorax (Fig. 2). Extensive blood investigations including immunoglobulin levels, connective tissue disease screen and alpha-1 antitrypsin level were unremarkable. Spirometry showed a forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio of 0.83, FVC of 2.56 L (59% of predicted), and FEV1 of 2.13 L (59% or predicted). Bronchodilator reversibility testing was not performed. Total lung capacity (TLC) measured via nitrogen washout method and body plethysmography showed an unsurprising discrepancy in results; TLC measured 3.43 L (56% of predicted) and 5.33 L (88% of predicted) respectively. However, the residual volume of 2.65 L (156% of predicted) suggested the presence of significant air trapping, making dynamic hyperinflation the most probable physiological explanation for the patient's breathlessness. Carbon monoxide diffusion capacity, adjusted for hemoglobin was unremarkable at 77% of predicted.

Bottom Line: An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed.Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases.This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

ABSTRACT
We describe a case of a young man presenting with exertional dyspnea. His chest radiograph showed hyperlucency in his left lung, and he was subsequently diagnosed to have giant bullous emphysema. An approach to lesions of decreased attenuation on computed tomography of the chest, with a focus on cystic lung diseases is discussed. This is followed by a literature review of the clinical presentation, natural history, radiology and management of giant bullous emphysema. Although this is an uncommon condition, a clinician has to be cognizant of the fact that it may mimic other common respiratory diseases. This review highlights the importance of these caveats as misguided treatment options may lead to devastating consequences.

No MeSH data available.


Related in: MedlinePlus