Citation

Ferreira Junior EG, Costa PA, Silveira LMFG, Almeida LEM, Salvioni NCP, Loureiro BM. Int. J. Surg. Case Rep. 2019; 56: 50-54.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.ijscr.2019.02.005

PMID

unavailable

Abstract

INTRODUCTION: Giant bullous emphysema (GBE) is defined by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding parenchyma [1]. Symptoms include dyspnea, hypoxia, chest pain and pressure, and hemoptysis [2], which can be complicated by pneumothorax and infection of the bullae [3]. Case presentation: A 50-year-old male was brought to the emergency department after he fell 5 m in a suicide attempt. The patient was in respiratory distress and had bilateral absence of breath sounds. He was intubated and bilateral chest tubes were inserted. A computerized tomography (CT) scan showed bilateral giant bullous emphysema in the upper lobes, confirming a diagnosis of GBE. As a result of the insertion of chest tubes, he developed bilateral high flow fistulas. During his hospitalization, he developed sepsis secondary to ventilator-associated pneumonia. In an attempt to control the fistulas, a right bullectomy was performed. Despite antibiotic treatment and surgical intervention, the patient died due to septic shock.

DISCUSSION: The clinical picture of a patient with GBE can be similar to that of pneumothorax, and GBE has been reported as being misdiagnosed as pneumothorax [4,5]. A CT scan can play an important role in differentiating these conditions [6], thus avoiding needle decompression, which can be catastrophic [6].

CONCLUSION: Giant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement. © 2019 The Authors

Language: en

Keywords

adult; human; male; case report; hospitalization; clinical article; priority journal; middle aged; sepsis; diagnostic error; computer assisted tomography; acute kidney failure; hemoptysis; pneumothorax; antibiotic therapy; respiratory distress; renal replacement therapy; Article; septic shock; respiratory acidosis; abnormal respiratory sound; rib fracture; lung emphysema; thorax drainage; ventilator associated pneumonia; vancomycin; piperacillin plus tazobactam; hip dislocation; Bullectomy; closed reduction (procedure); Giant bullous emphysema; Traumatic pneumothorax; Vanishing lung