A Case of Infected Giant Bulla Treated by Opening the Cyst Wall

Abstract

A 54-year-old man presented with fever and chest pain during his visit to our clinic for smoking cessation. Chest CT revealed a giant bulla in the right thoracic cavity that compressed the upper lobe and a fluid effusion in the cyst. He was diagnosed with an infected giant bulla and started antibiotics therapy. About 2 weeks later, chest CT showed increased pleural effusion with unchanged fluid retention in the cyst. Surgery was performed because drainage of the cyst was considered necessary. The upper lobe including the cyst wall was inflammatory and adhered to the chest wall. After debridement of the adhesion, the cyst wall was cut open, and purulent fluid was observed. The Naclerio-Langer technique or its variants should be avoided from the viewpoint of infection control, and we resected the cyst wall widely on the thoracic wall side and opened the cyst cavity. Air leak test was performed and the bronchial orifice at the bottom of the cyst was ligated. After thorough cleaning with saline, the cyst was covered with a polyglycolic acid sheet and fibrin glue. The patient had a good postoperative course, and the thoracic drain was removed on postoperative day 13. We report this case because there are few reports of surgery for infected giant bulla.