Pneumothorax, bullous disease, and emphysema

Abstract

This article addresses several distinct but related pulmonary conditions that are commonly referred to general thoracic surgeons for decision making and management. The management of various types of pneumothorax is reviewed, with particular attention to the selection of the appropriate level of surgical intervention. The related entities of bullous lung disease and diffuse emphysema are discussed, with a focus on the identification of appropriate circumstances for surgical intervention. The summarized work and the treatment recommendations are supported with an extensive bibliography of important work in this area.

Fig. 1

Twenty-year-old man with a right-sided spontaneous pneumothorax. The compressed and collapsed right lung, and the widened intercostal distance on the right side, all suggest a degree of tension pneumothorax is present. Successful management took place with a 19 French percutaneous chest catheter.

Fig. 2

Several different states of lung disease present in a patient with giant bulla. The large right-sided bulla is evident as the homogeneous hypodense region in the right hemithorax. Some residual septae are evident posteriorly and medially. There is comparatively normal lung on the opposite side. There is compressed and atelectatic lung adjacent to the mediastinum, likely caused by the pressure of the bulla.

Fig. 3

(A) CT radiograph of a patient who underwent lung reduction surgery. Both upper lobes are diseased. The right side shows more extensive bullous changes, whereas the left side has emphysematous destruction without macroscopic bullae. (B) Lower cuts in the same the patient show relatively normal lung parenchyma and pulmonary vessels near the base of the lungs. This degree of heterogeneity is often seen in the patients who experience the best response to LVRS.