Abstract
This study presented a classification for giant bullae from the view point of chest wall motion and changes in pulmonary function after bullectomy. The diaphragm-rib cage motion and their relationship during breathing efforts in the supine position were evaluated based on analysis of serial lateral chest X-rays in 23 patients with giant bullae. We measured craniocaudal displacement of the diaphragm and posteroanterior displacement of the rib cage.
Patients were divided into two groups. Eight patients (Group A) had a phase shift between the diaphragm motion and the rib cage motion or abnormal diaphragm motion. Almost all of them had dyspnea or chest pain, and %FVC, FEV1.0, MVV%pred., and V25/HT showed impaired values. Fifteen patients (Group B) had as good coordination of the diaphragm and rib cage motion as normal subjects. A large number of patients in this group had no dyspnea and normal pulmonary function.
Six patients in Group A and thirteen patients in Group B underwent bullectomy. The MVV%pred. in Group A increased significantly from three months after the operation, and RV/TLC decreased significantly since six months after the operation. Almost all of the patients in Group A showed improvement in symptoms. In contrast, the %FVC of Group B decreased three months after bullectomy and returned to the preoperative value six months later. The FEV1.0 in Group B increased significantly one year after the bullectomy.
We conclude that the classification for giant bullae from the analysis of diaphragm-rib cage motion with the use of serial chest X-rays can provide useful information about the pathophysiology of giant bullae indications of bullectomy.
