Abstract
A 40-year-old man who had a 22-year smoking habit (40 cigarettes per day) had been pointed out a bulla in the upper lobe of the right lung at annual examinations. The bulla tended to increase, but the clinical course had been observed because he was asymptomatic. A chest CT scan revealed that the bulla almost entirely occupied the upper lobe of the right lung or more than half of the thoracic cavity while it oppressed the middle and lower lobes. The patient presented to our hospital because of a one-week history of right chest pain. Following close exploration, right spontaneous pneumothorax was diagnosed, and right upper lobectomy of lung was performed on the next day. After the operation, the patient developed reexpasion pulmonary edema, prolonged pulmonary fistula, and impaired expansion of the remnant middle and lower lobes, but respiratory function improved.
Since no clear criteria for surgical indication for giant bullae have been established as yet, asymptomatic patients are often indicated clinical observation. In this case, the patient was indicated surgery because he presented with spontaneous pneumothorax, however, the observation resultantly allowed the bulla to grow larger. We had to resect extensive area of the lung that might affect his postoperative course. Periodic examinations and evaluation of the respiratory function and surgical therapy at an appropriate time are necessary for giant bullae.
