Placental Transmogrification of the Lung in a Patient Without Emphysematous Disease

Abstract

We present a 47-year-old male without a relevant history or past respiratory diseases. He debuted with an acute, non-complicated COVID-19 infection, and later he started with mMRC-2 dyspnea, accompanied by a non-expectorant cough of four months evolution. A CT thoracic scan showed a dilatation of the aerial homogenous space and a well-defined anterior left pericardiac level, and a pericardial left bulla was diagnosed. The patient was treated with surgical intervention by video-assisted thoracoscopic surgery and had an adequate post-surgical evolution. The PPT must be managed by a multidisciplinary team with the definitive treatment of surgical resection.

Keywords: minimally invasive lung resection; pulmonary bulla; pulmonary placental transmogrification; thoracic ct scan; thorax surgery.

Figure 1. (A-B) Dilatation of the aerial homogenous space and a well-defined anterior left pericardiac level of 4.6 cm × 4.4 cm × 3.5 cm dimensions of thin wall, with a 1 mm thickness (yellow arrow)

Figure 2. Placement of laparoscopic stapler in anterior segment of left lung

Figure 3. Laparoscopic stapler line posterior to wedge resection (yellow arrow)

Figure 4. Bulla resection with view of macroscopic pathological specimen

Figure 5. (A-D) Histopathological findings showing alveolar septa (A) with a fragment of emphysematous bulla wall (C) and intraluminal presence of vascular/capillary structures with a papillary appearance and with proliferation of associated pneumocytes reminiscent of placental chorionic villi (B/D)