188 Lung Volume Reduction Surgery (LVRS) for Giant Bullous Emphysema

Clinical Presentation

57-year old man with shortness of breath

Radiologic Findings

PA chest radiograph (Fig. 188.1A) demonstrates pulmonary hyperinflation with diaphragmatic flattening and increased lucency with giant bullae in both lungs. Compressive changes are noted in the right lower lobe with crowding of bronchovascular structures. Unenhanced chest CT (Fig. 188.1B) shows giant bullae in both lungs, right larger than left, with leftward shift of the mediastinal structures. PA chest radiograph following lung volume reduction surgery (Fig. 188.1C) demonstrates reduction in overall lung volumes, increased upward convexity of the left hemidiaphragm, and improved aeration in the lung parenchyma bilaterally. A subpulmonic effusion obscures the right lateral sulcus and displaces the apex of the diaphragm laterally.