Idiopathic giant bullous emphysema
Idiopathic giant bullous emphysema, also known as vanishing lung syndrome (VLS), is characterised by giant emphysematous bullae, which commonly develop in the upper lobes and occupy at least one-third of a hemithorax. It is a progressive condition that is also associated with several forms of emphysema.
Idiopathic giant bullous emphysema is a rare syndrome that differs from conventional forms of bullous emphysema; affecting a younger population, most commonly young men 1-2.
Most affected patients smoke cigarettes.
The condition has been associated with:
Affected patients may be asymptomatic or experience hypoxia, severe dyspnea,
hypoxia, and chest pain.
The bullae tend to be on upper lobes with an asymmetric distribution, and to arise more in the paraseptal location.
Plain film features can be non-specific
- bullae occupy more than one-third of the affected hemithorax (vary in size 1-20 cm);
- upper lobes have greater involvement
- there is bilateral and asymmetric lung involvement;
- may have compress effect to adjacent structures (lung parenchyma atelectasis, invert the ipsilateral diaphragm or contralateral displacement of the mediastinum and displacement of junction lines)
High-resolution chest CT is used to assess the extent of disease and determine
suitability for lung volume reduction surgery:
- bullae predominant in subpleural location
- reported size ranges of bullae include-often 1 to 20 cm in diameter, but most were 2-8 cm in diameter 2
- usually asymmetric, with one lung involved to greater extent than the other
- the presence of concomitant foci of paraseptal and centrilobular emphysema
Treatment and prognosis
The condition tends to be progressive. Criteria for bullectomy include large bullae with significant symptoms (reduced lung function or infection).
- compression of surrounding lung pneumothorax
- bullae infection
- patients have a higher risk of lung cancer
History and etymology
In 1937, Burke described a case of “vanishing lungs” in a 35-year-old man who had progressive dyspnea, respiratory failure, and radiographic and pathologic findings of giant bullae that occupied two-thirds of both hemithoraces.
- 1. Sharma N, Justaniah AM, Kanne JP et-al. Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 2009;24 (3): 227-30. doi:10.1097/RTI.0b013e31819b9f2a - Pubmed citation
- 2. Stern EJ, Webb WR, Weinacker A et-al. Idiopathic giant bullous emphysema (vanishing lung syndrome): imaging findings in nine patients. AJR Am J Roentgenol. 1994;162 (2): 279-82. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Stern EJ, White CS. Chest radiology companion. (1999) ISBN:0397517327. Read it at Google Books - Find it at Amazon