An Interesting Case of Vanishing & Reappearing LUNG SYNDROME

Vanishing Lung Syndrome is a rare radiological condition in which the lungs disappear on the X-ray. It is a chronic, progressive condition characterized by giant emphysematous bulla, which compresses the remaining normal lung. The commonest differential diagnosis is Tension Pneumothorax.

The 62-year-old obese lady had gradually worsening dyspnoea for 5 years. A chest X ray and CT scan were done in 2017 and they revealed a large bulla in the right lung, compressing the normal lung and shifting the mediastinum to left, thus also compressing the normal left lung.

Surgery was clearly indicated but she was advised against it, as it was considered to be of very high risk. The bulla continued to enlarge and almost the entire right lung disappeared. She had multiple episodes of LRTI requiring hospitalization and higher antibiotics. Dyspnoea progressed to the point that she needed home oxygen therapy and became kind of a respiratory cripple.

She was referred to Aadicura for a surgical opinion. After discussing the pros and cons of the surgery with the family, the patient was accepted for the same. Her routine pre-operative workup was normal. Thoracotomy was done from the right fifth intercostal space. A large bulla arising from the superior segment of the right lower lobe almost popped out of the incision. The rest of her entire lung collapsed. Bulla was opened and all air-leaking bronchioles were painstakingly identified and closed. To restore the normal lung anatomy, the bulla cavity was obliterated by suturing the margins of the bulla wall with each other (capitonnage).

The surgical result was surprisingly good. All three lobes of the right lung expanded very well and filled up to 80% of the chest cavity. She tolerated surgery and anaesthesia very well. She made a slow but complete recovery. Lung took time to expand completely.

The expansion was aided by continuous low suction on chest drains. Due to the rising total counts, she needed an escalation of antibiotics. She was discharged on day 12 with a fully expanded lung, no air leak, no fever, off oxygen, and was able to climb one flight of stairs.

Thanks to the specialists:
Dr. Apurva Vaidya (Cardiothoracic Surgeon)
Dr. Hiren Parikh (Interventional Pulmonologist)
Dr. Hardik Shah (Interventional Pulmonologist)
Dr. Ravirajsinh Gohil (Critical Care Specialist)