Læknablaðið - 15.10.2008, Page 29

FRÆÐIGREINAR
SJÚKRATILFELLI
horf. í okkar tilfelli sást þetta greinilega í aukningu
á fráblástursrúmmáli þar sem FVC-gildi hækkuðu
um 22% og FEVl-gildi um 18% (tafla I). Árangur
aðgerða virðist vera betri eftir því sem blöðrurnar
eru stærri og staðbundnari og oftast er árangurinn
viðvarandi (2, 4, 14, 16). Hjá sjúklingum með út-
breidda lungnaþembu er langtímaárangur síðri og
sumum þessara sjúklinga er ekki treyst í aðgerð
vegna þess hversu lungnastarfsemi er skert. I
þeim tilvikum kemur til greina að koma fyrir ein-
stefnuloka í berkjutréð í berkjuspeglun og tæmast
blöðrurnar þá við útöndun. Þetta er nýtt meðferð-
arúrræði og virðist lofa góðu (17).
Þakkir
Þakkir fá Gunnar Rafn Jóhannesson heimilislækn-
ir, Ólafur Baldursson lungnasérfræðingur fyrir
yfirlestur, Kristín Bára Jörundsdóttir hjúkrunar-
fræðingur á lungnarannsóknarstofu Landspítala
og Inger Helene Bóasson ljósmyndari.
Heimildir
1. Panchal NJ, Stark P. Bullous lung disease: a review.
Contemporary Diagnostic Radiology 2006; 29:1-5.
2. Snider GL. Reduction pneumoplasty for giant bullous
emphysema: implicationsforsurgical treatmentofnonbullous
emphysema. Chest 1996; 109: 540-8.
3. Morgan MD, Edwards CW, Morris J, Matthews HR. Origin
and behaviour of emphysematous bullae. Thorax 1989; 44:
533-8.
4. Schipper PH, Meyers BF, Battafarano RJ, Guthrie TJ,
Patterson GA, Cooper JD. Outcomes after resection of giant
emphysematous bullae. Ann Thorac Surg 2004; 78: 976-82.
5. Shah NN, Bhargava R, Ahmed Z, et al. The vanishing lung.
CJEM 2007; 9: 233-4.
6. Stem EJ, Webb WR, Weinacker A, Miiller NL. Idiopathic
giant bullous emphysema (vanishing lung syndrome):
imaging findings in nine patients. AJR 1994; 162: 279-82.
7. Magnússon B, Jóhannsson K, Guðjónsdóttir M, Ásmundsson
T. Lífeðlisfræðileg áhrif skurðaðgerðar á stómm
lungnablöðrum hjá þremur sjúklingum með langvinna
lungnateppu (LLT). Læknablaðið 1994; 80; fylgirit 25: 67.
8. Ogawa D, Shiota Y, Marukawa M, et al. Lung cancer
associated with pulmonary bulla. Respiration 1999; 66: 555-
8.
9. Waseem M, Jones J, Brutus S, Munyak J, Kapoor R,
Gernsheimer J. Giant bulla mimicking pneumothorax. J
Emerg Med 2005; 29:155-8.
10. Wanger J, Clausen JL, Coates A, et al. Standardisation of the
measurement of lung volumes. Eur Respir J 2005; 26: 511-22.
11. Shinonaga M, Yamaguchi A, Yoshiya K. VATS-stepwise
resection of a giant bulla in an oxygen-dependent patient.
Surg Laparosc Endosc 1999; 9: 70-3.
12. Mehran RJ, Deslauriers J. Indications for surgery and patient
work-up for bullectomy. Chest Surg Clin N Am 1995; 5: 717-
34.
13. Van Natta TL, Iannettoni MD. Reduction pneumoplasty for
a giant right upper lobe bulla causing massive bilateral lung
compression. J Thorac Cardiovasc Surg 2007; 133:1674-5.
14. Neviere R, Catto M, Bautin N, et al. Longitudinal changes in
hyperinflation parameters and exercise capacity after giant
bullous emphysema surgery. J Thorac Cardiovasc Surg 2006;
132:1203-7.
15. Schnater JM, Plaisier PW, van den Berg PM, Schutte PR.
A remarkable outcome after video-assisted thoracoscopic
resection of a giant bulla. Interact Cardiovasc Thorac Surg
2003; 2: 589-91.
16. Palla A, Desideri M, Rossi G, et al. Elective surgery for giant
bullous emphysema: a 5 year clinical and functional follow-
up. Chest 2005; 128: 2043-50.
17. Noppen M, Tellings JC, Dekeukeleire T, et al. Successful
treatment of a giant emphysematous bulla by bronchoscopic
placement of endobronchial valves. Chest 2006; 130:1563-5.
Ásgeirsson H, Lúðvíksdóttir D, Kjartanson O, Guðbjartsson T
A 49 year old male with a giant pulmonary bulla
- a case report and review of the literature
A 49 year old previously healthy smoker was diagnosed
with a giant bulla in his right lung, following a history of dry
cough, repeated upper airway infections and increasing
dyspnea for several years. Computed tomography (CT)
confirmed the presence of a giant bulla in the right inferior
lobe and several smaller bullae in the right superior
lobe. The giant bulla was 17 cm in diameter, occupying
more than half of the right hemithorax. On spirometry a
moderate restrictive and a mild obstructive pattern was
observed. Lung volume was measured with two different
techniques, nitrogen washout and plethysmography, with
volume of the bullae estimated at 2.9 L, similar to the 3.2
L determined by CT. The patient underwent thoracotomy,
where the giant bulla together with the inferior lobe
were removed with lobectomy and the small bullae in
the superior lobe with wedge resection. Five months
postoperatively the patient is in good health and is back
at work. Postoperatively significant improvements in
spirometry values and lung volume measurements have
been documented. This case demonstrates that giant
bullae can be successfully managed with surgical resection
and their size can be determined by different techniques,
including lung volume measurements and chest CT.
Key words: Giant buila, diagnosis, treatment, thoracotomy, iung voiume measurements.
Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is
>
CC
<
2
I
«
_l
o
z
Lil
Barst: 19. apríl 2008, samþykkt til birtingar: 22. ágúst 2008
LÆKNAblaðið 2008/94 677
ns