Vanishing Lung Syndrome: A Rare Entity

Vanishing lung syndrome is characterised by giant bullae that compress the underlying lung. Differentiating between bullous emphysema and pneumothorax and choosing the right treatment modality can be challenging. The present report describes a case of a giant pulmonary bulla in a young male patient. A 20-year-old male was admitted with complaints of shortness of breath, chest pain, sweating, and tachycardia. Chest X-ray and chest CT images revealed the presence of giant bullae occupying the left hemithorax and pneumothorax. A chest tube was inserted percutaneously under local anesthesia into the pleural cavity and then we performed bullectomy using thoracoscopic surgery. Residual lung re-expansion yielded good postoperative results without complications. It can be very difficult to distinguish a pneumothorax from a giant bulla and preoperative assessment of the extent and distribution of the bullae is vital for the following procedures. Keyword: Giant Bulla; Pulmonary Emphysema; Pneumothorax. Vanishing Lung Sendrom: Nadir Bir Antite Özet Vanishing lung sendrom nadir görülen ve dev bül veya büllerin akciğerin büyük oranda kollapsına neden olduğu bir antitedir. Bu çalışmada solunum sıkıntısı, terleme, çarpıntı şikayeti ile acil servise başvuran 20 yaşında, radyografik olarak sağ hemitoraksın tümünü kaplayan dev bül ve çevresinde pnömotoraks saptanan bir erkek hasta sunuldu. Hastaya tüp torakostomi uygulandı ve daha sonra torakoskopik cerrahi ile bül eksizyonu yapıldı. Postoperatif dönemde komplikasyon gelişmedi. Akciğer ekspanse olan olgu postop 6. günü şifa ile externe edildi. Vanishing lung sendromunda en önemli sıkıntı bül, pnömotoraks ayrımının yapılmasında ve altta yatan akciğer parankiminin ne derece sağlıklı olduğunun değerlendirilmesinde yaşanılan zorluktur. Uygun vakalarda bül eksizyonu ile kollabe akciğerin ekspanse olur ve tam bir klinik düzelme sağlanır. Anahtar Kelimeler: Dev Bül; Pulmoner Amfizem; Pnömotoraks. "Vanishing lung syndrome" (VLS) is characterised by one or more giant bullae filling almost all regions of a hemithorax while collapsing underlying lung tissues. PA defines a radiological entity in which lung tissue can hardly be seen in chest X-ray. Clinically and radiologically it is difficult to make the differential diagnosis between bullous emphysema and pneumothorax. In this article, we present the case of a patient who was admitted with respiratory distress symptoms and was diagnosed with secondary "vanishing lung" with a giant pulmonary bulla in radiological assessment. A 20-year-old male patient was admitted with shortness of breath that had been continuing for seven days, chest pain, sweating, and palpitation. The patient did not have any coughing and fever complaints. He had been smoking eight pack-year. Routine biochemical and hematological tests showed normal results. PA chest radiograph revealed increase in radiolucency in the right hemithorax, expansion in the intercostal space, flattening of the right hemidiaphragm and minimal mediastinal shift to the left hemithorax (Figure 1). Figure 1. PA chest radiography image showing the hyperlucent view in the right hemithorax, expansion in the intercostal space, flattening of the right hemidiaphragm and minimal mediastinal shift. In the thorax CT, we detected a giant bulla with accompanying minimal pneumothorax which filled the right hemithorax causing a nearly total collapse of normal lung tissues and mediastinal shift (Figure 2). INTRODUCTION