Case Presentation

A 58-year-old white woman with severe emphysema was evaluated in our LVRS clinic. Her CT scan (Fig 1, left) showed centrilobular emphysema predominantly involving the upper lobes. After initial workup and pulmonary rehabilitation, she underwent bilateral LVRS through median sternotomy. Three months postoperatively, she improved subjectively and objectively, as shown by pulmonary function tests (Table 1). In the third year after LVRS, she gradually became more dyspneic and was referred back to the LVRS clinic. The CT scan (Fig 1, right) now showed development of a giant bulla in the right upper lobe occupying more than one third of the right hemithorax. Serial chest radiographs (not shown here) at 3 and 6 months postoperatively showed no evidence of bullous disease. Radiographs at 1 year after LVRS revealed the development of a bulla in the right upper lobe less than one third the size of the hemithorax. Subsequent films after 3 years showed the growth of the bulla. Serial pulmonary function tests are shown in Table 1. Pressure-volume (PV) curves are shown in Figure 2, top, A. Maximal static recoil pressure improved 3 months after surgery, although specific compliance remained unaltered. asthma medications inhalers

Figure 1

Figure 2
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