Surgical treatment of bilateral vanishing lung syndrome: a case report

• Published in: Journal of cardiothoracic surgery 2020-07, Vol.15 (1), p.201-201, Article 201
• Main Authors: Giller, Dmitry Borisovich, Scherbakova, Galina Vladimirovna, Giller, Boris Dmitrievich, Khanin, Arkadyi Leybovich, Nikolenko, Vladimir Nikolayeich, Sinelnikov, Mikhail Yegorovich
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Bullous emphysema; Care and treatment; Case Report; Case reports; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Complications; Computed tomography; COPD surgery; Cough; Dyspnea; Electrocardiography; Emphysema; Forced Expiratory Volume; Gigantic lung bullae; Health services; Humans; Lung diseases; Lungs; Male; Medical research; Medical treatment; Obstructive lung disease; Olodaterol; Patients; Pneumonectomy - methods; Pneumothorax; Pneumothorax - surgery; Postoperative Complications - surgery; Postoperative Period; Pulmonary arteries; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - surgery; Pulmonary Emphysema - diagnostic imaging; Pulmonary Emphysema - physiopathology; Pulmonary Emphysema - surgery; Rehabilitation; Reoperation; Respiration; Respiratory function; Risk management; Rupture; Rupturing; Severity of Illness Index; Spirometry; Spontaneous pneumothorax; Sputum; Surgery; Syndrome; Thoracic surgery; Thoracic Surgery, Video-Assisted; Tiotropium; Tomography, X-Ray Computed; VATS; Vital Capacity
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-020-01246-4

Volume reduction surgery is a routine treatment method for lung emphysema in chronic obstructive pulmonary disease (COPD) patients. The formation of giant bullous emphysema is an indication for surgical bullectomy. Bilateral giant bullae severely compromise lung function and complicate surgical treatment. We present the algorithm for surgical treatment and correction of complications in a 38-year-old male with bilateral giant bullae (vanishing lung syndrome), severe COPD. Primarily the patient was admitted with a mild cough, mucopurulent sputum and dyspnea. A CT scan revealed bilateral giant bullae, displacing up to 50% of lung volume. A two-stage surgical bullectomy was planned, yet postoperative complications due to secondary bullae rupture prompted urgent revision with contralateral bullae resection. After complete bullectomy, severely reduced lung volume was successfully managed throughout a long postoperative rehabilitation period. At 5 year follow-up, spirometry indicators and radiological examination show significantly improved and stable lung function. This clinical case demonstrates the technical difficulties and possible complications of extended bilateral lung resections in patients with severe vanishing lung syndrome. Single-stage treatment of bilateral giant bullous emphysema is recommended to minimize postoperative complications and reduce risk of bullae rupture. Positive long-term outcome outweighs possible complications of surgical treatment.