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14 November 2022 : Case report  USA

[In Press] Vanishing Lung Syndrome, or Idiopathic Giant Bullous Emphysema, with Pneumothorax, and Subcutaneous Emphysema in a 58-Year-Old Female Smoker with Chronic Obstructive Pulmonary Disease

Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents

Haris Sohail ORCID logo1ABEFG, Yassine Kilani1ABEFG, Julieta Osella2BEFG, Ashna Syeda Fatima Kamal3BEG, Barkha Kumari1BEFG, Daniel Emnet Keftassa1EFG, Mubarak H. Yusuf ORCID logo1EG, Mohammad Aldiabat1EG, Ali Horoub1EG, Shekar Murthy1EG

DOI: 10.12659/AJCR.938063

Am J Case Rep In Press; DOI: 10.12659/AJCR.938063  

Available online: 2022-11-14, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is a rare manifestation of chronic obstructive pulmonary disease (COPD) and usually occurs in middle-aged smokers. This report presents a 58-year-old female smoker with COPD and VLS who presented with spontaneous pneumothorax. The pneumothorax was managed with a chest tube and was later complicated by massive subcutaneous emphysema.
CASE REPORT
A 58-year-old woman with a past medical history of long-term smoking and COPD presented with worsening shortness of breath. Upon initial evaluation, she had tachypnea and hypoxia (SpO₂ 93%). Chest radiography revealed a new right-sided pneumothorax on top of extensive bullous disease, which the patient already had. The drainage of the pneumothorax was successful with a pigtail catheter. However, during the following night, after insertion of the pigtail catheter, the patient developed massive subcutaneous emphysema, which was confirmed with imaging. The patient remained hemodynamically stable, and diffuse subcutaneous crepitus was present on examination. The pigtail catheter was repositioned, resulting in complete resolution of the subcutaneous emphysema in the following 2 weeks.
CONCLUSIONS
This case highlights the importance of a timely diagnosis and management of the possible presentations and complications of VLS. Complications such as pneumothorax are life-threatening and require urgent management, taking precedence over the curative treatment for VLS, surgical bullectomy.

Keywords: Emphysema; Pulmonary Bullae Causing Pneumothorax; Subcutaneous Emphysema

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923