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The 3-year curve showed decreased maximal recoil pressure compared with 3 months, but it was still greater than it was before the LVRS. Static recoil-maximum flow curves (Fig 2, right, B) demonstrated improved flow rates 3 months after LVRS. However, by 3 years, there was decreased maximum expiratory flow at any given recoil pressure. An echocardiogram showed an estimated peak pulmonary systolic pressure of 40 mm Hg with normal left ventricular function. She underwent giant bullectomy but died postoperatively following massive intrathoracic bleeding and ARDS. The cause of bleeding could not be determined.

Discussion

The long-term prognosis and the effect of LVRS on the lung mechanics have not yet been characterized in detail generic claritin. This case reports the development of a giant bulla as a late complication of LVRS, a finding not previously reported.

Different mechanisms of bulla formation have been suggested. One postulate is a ball valve mechanism in a small airway subtending the distended airspace. Air is progressively trapped in alveoli distal to the obstruction and expands to form a bulla. However, bronchi connecting with bullae are patent, thus rendering this explanation implausible.
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