Abstract
This study presents a classification of giant bullae based on analysis of the effects of giant bullae on adjacent lung tissues and changes in pulmonary function after bullectomy. The diaphragm-bulla motion and their relationship during breathing in the supine position were evaluated by analysis of serial posteroanterior chest X-rays in 9 patients with giant bullae whose diaphragm-rib cage motion were synchronous. We measured craniocaudal displacement of the diaphragm and bullae.
Patients were divided into three groups according to diaphragm bulla motion. First, three patients whose diaphragm bulla motion had no phase shift had normal values in spirometric pulmonary function test before bullectomy, and showed decrease in %VC (p 0.05), FEV1.0, MVV%pred. and increase in RV/TLC after bullectomy. These impaired values returned to almost the same level one year after the operation. Second, three patients whose bullae inflated in the early expiratory phase and compressed adjacent lung tissues showed no changes on tests except a decrease in RV/TLC one year after the operation. Third, three patients whose bullae inflated at the end of the expiratory phase or kept their size during respiration showed improvement in FEV1.0 and MVV%pred. from early postoperative course and%VC also increased.
We conclude that the classification of giant bulla according to the diaphragm-bulla motion can provide useful information for evaluating the pathophysiology of giant bullae and predicting of pulmonary function after bullectomy.
