Giant apical bulla

Case contributed by Yen-Chung Liu


Heavy smoker, complains of chronic left chest pain and a feeling of pressure on the left chest about six months. History of tuberculosis, no other marked disease was found.

Patient Data

Age: 35 years
Gender: Male



Giant pulmonary bulla (represented by a hyperlucent zone) in the upper zones of the left lung. Right apical fibrosis. 



A single giant bulla in the left upper lobe, the bulla was 10 cm in diameter, occupying nearly 30% of the left hemithorax, no underlying pulmonary disease was found, except right upper lobe tubercular lesion.

Case Discussion

The patient also had history of pulmonary tuberculosis 10 years ago, for which he took anti-tubercular treatment for 12 months and was declared cured. During the VATS bullectomy, we found a dense pleural adhesion in the left hemithorax, which makes the surgery much more difficult, fortunately, the post-operation recovery is uneventful.

Vanishing lung syndrome was first reported by Burke in 1937 1, Roberts first presents the radiographic criteria for this condition: the presence of a giant bulla in one or more upper lobes (mostly unilateral), occupying at least one-third of the hemithorax and compressing surrounding normal lung parenchyma 2.

Giant bullous emphysema is most frequent in young male smokers 3. Pulmonary bullae are also associated with primary lung cancer, the incidence is 4.2% reported by Venuta, so a strict follow up is required 4.

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