Roentogram admission chest was returned ...

42-year-old man with chronic obstructive pulmonary disease (COPD) presented to the emergency department (ED) complaining of worsening shortness of breath and respiratory failure. His house was the need for oxygen 2 liters per nasal cannula, and it was something to hospitalization for respiratory failure. His last admission was 3 days before presentation, and require a short period of tracheal intubation and management in the medical intensive care unit (MICU). He has a medical history of asthma in children politoksikomaniya and hepatitis B and C. It is a 45-pack-year history of smoking and currently smoking cigarettes 06.05 a day. The patient was hemodynamically stable and fever. However, the pulse oximeter registered 70%, because the patient receives 4 liters of oxygen via nasal cannula. On physical examination, the patient has decreased breath sounds in the right upper chest and diffuse expiratory wheezing. Arterial blood gas (SAC) in the ED showed pH 7. 23 PaCO2 126 mmHg, PaO2 37 mm Hg and SaO2 72%. Roentogram admission chest was obtained and showed a large right upper lobe lucency without evidence of pneumothorax (

Fig. 1). The patient endotracheally intubation in the ED for respiratory failure, and repeat ABG (pH = 7. 39, PaCO2 83 mm Hg, PaO2 160 mm Hg, SaO2 92%) of ventilator settings respiratory volume 500 ml, no positive in end expiratory pressure, respiratory rate 20 breaths per minute, and 50% FiO2 showed improvement. After intubation, the patient entered the MICU and aggressive treatment of pulmonary held. Intravenous steroids frequently spray and intravenous antibiotics administered. Chest computed tomography (CT) showed massive right apical bullae is almost a third of the right half of a bunch of cells, and several smaller bullae observed in all the right and left lungs (

Fig. 2). The patient then improved, and could be Extubation in the morning the next day the hospital. After Extubation ABG on 2 liters of oxygen via nasal cannula was pH 7. 36, PaCO2 85 mm Hg, PaO2 55 mm Hg and SaO2 85%. Pulmonary function tests (PFTS) showed FEV1 0. 39 liters (9% of the good) and FVC 0. 8 liters (16% good). The patient returned to his baseline lung following provisions continued medical and pulmonary therapy. It was clear that giant right upper lobe bulla had caused his compress pulmonary parenchyma and interfere in his lung mechanics. Thus, the patient received the right to selectively thoractomy and stapling resection of the right upper lobe bullae (

Fig. 3). There were several small bullae distributed in the remaining lung tissue, and they were not resection because of their diffuse nature. Sample remote measured 9. 5 cm x 5. 5 cm lasix 40 mg ivp x 4. 0 cm, and represented benign lung tissue from pathological examination (

Fig. 4). Patient complications postoperative recovery and was discharged home on nasal cannula 2 liters. Later he was able to break-home oxygen and his exercise tolerance improved. Comments Bullous lung disease is a rare cause of respiratory failure []. In patients with severe emphysema, emphysematous bullae discrete been shown to functionally disrupt mechanics of the lungs and leads to a decrease in exercise tolerance and even acute respiratory failure [

]. Most patients with bullae have a significant history of smoking, although smoking cocaine, pulmonary sarcoidosis, 1-antitrypsin, 1-antihimotripsina deficiency syndrome Marfans Elersa-Danlosa and inhalation effects fiber has been shown that due to emphysema bullae [

] .

Bull, which increases enough to compress adjacent lung tissue is best diagnosed by CT. Double walled Sign CT of the chest demonstrating air on both sides of the wall bull, means associated with pneumothorax bull [

]. In addition to CT of the chest, these patients should undergo SAC and PFTS management solution is often difficult. Patients should undergo surgical removal, when they neutralized dyspnea with large bullae that fill more than 30% half a bunch of cells and the resulting compression of healthy adjacent lung tissue [

]. In addition, the operation indicated for patients who have complications related to bullosa diseases such as infection or pneumothorax [

]. There are two approaches to surgical resection of giant bullae lung. Stitch resection of all bull, or VATS and open approach is the most common method [

]. Pericardial strips can be used for the main line to help control air leakage, as well as the surrounding lung tissue is often sick. Another approach is operational change Monaldi technique which involves the opening of bull, placing kisetnyy seam on the neck of bull and closing the upper bulluous bag of running back and forth stitch forming folds [

]. Both methods were shown to be effective. Stopping smoking and aggressive pulmonary rehabilitation are also important for successful treatment of patients with lung disease bullosa. .