The vanishing lung

Case report

A 48-year-old woman with medical history significant for 20 pack-years of smoking presented with decreased exercise tolerance for the last year. On examination, her respiratory rate was 18 and oxygen saturation was 96% on room air with absent breath sounds within the left lung field. Alpha-1 antitrypsin levels were normal. Chest radiograph revealed giant emphysematous bulla with concern for concurrent pneumothorax (figure 1). CT scan of the chest revealed a massive bulla without a 'double wall sign' making superimposed pneumothorax unlikely (figure 2). Chest tube insertion was deferred and patient underwent bullectomy. Prior to surgery, her exercise tolerance was 1–2 blocks which improved to 7–8 blocks 2 months postsurgery.

Discussion

Giant bullous emphysema or vanishing lung syndrome (VLS) is defined as a large bulla occupying at least one-third of hemithorax leading to displacement of adjacent lung tissue. VLS is often complicated by...

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