A surgical case of adult giant tension bulla

Abstract

A 44-year-old man presented to a local general physician (GP) with gradually deteriorating dyspnea lasting for a few days. The patient was referred to our hospital with the GP's diagnosis of left-sided tension pneumothorax. Computed tomography (CT) revealed that he didn't have tension pneumothorax but a giant tension bulla, which required emergency bullectomy. General anesthesia was started using rapid sequence induction minimizing positive pressure ventilation to avoid cardiopulmonary failure. Because of its rarity in adult cases and its diagnostic similarity, giant tension bulla might be misdiagnosed as tension pneumothorax, although those two diseases should be managed quite differently. CT is useful to distinguish between those two diseases and careful interview focusing on the duration and onset of dyspnea would also be helpful, suggesting giant tension bulla and not tension pneumothorax.