A A Rare Case of Giant Pulmonary Bullae Compressing the Heart with a Brief Review

Abstract

Introduction: An air space of >1cm and air space occupying >1/3 of hemithorax are called as bullae and Giant Pulmonary Bullae (GPB), respectively. GPBs are rare and usually accompany smoking abuse-related diseases. The GPB may lead to hypoxia and or mass-like compression effect on neighboring healthy lung and mediastinum. The bullectomy is the gold standard but in surgically unfit cases one has to select result result-oriented, minimal-invasive procedure with considering risk and benefit.
Case report: A 27-year-old chest symptomatic female with idiopathic GPB occupying most of the right hemithorax with herniation to the contralateral side was detected on CT thorax with low cardiac ejection fraction on ECHO. A tremendously improved cardiac ejection fraction from 30 to 58% was achieved after a simple percutaneous intracavitary placement of a pigtail catheter with an underwater seal carried out with local anesthesia. Also, she could be weaned off from O2 support.
Discussion: In a surgical unfit case of GPB the number of bullae, its size, site, and location (unilateral or bilateral) with evaluation of the underlying condition of lung and comorbidity is a prerequisite for intervention. An alternate minimally invasive procedure is to have opted to decompress the GPB. Spontaneous pneumothorax is the most common complication GPB, even without a percutaneous procedural approach, and can easily be managed with an underwater seal drainage tube.
Conclusion: The GPB may lead to chronic hypoxia and a mass-like effect, so to avoid life-threatening emergency situations decompression of GPB be considered followed by resection