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A 65‐year‐old woman was brought to the emergency unit with an approximately 6‐month history of persistent fever and cough. Chest computed tomography (CT) demonstrated a 16‐cm heterogeneous mass with adjacent large cyst (approximately 4.0 cm). The patient underwent CT‐guided biopsy, and benign solitary fibrous tumour (SFT) was immunohistochemically diagnosed. As the symptoms were thought to be due to enlargement of the tumour, surgery was deemed necessary, and the tumour was successfully resected. Based on morphological and immunohistochemical examination of the resected specimen, the final diagnosis was dedifferentiated SFT (DSFT). Follow‐up CT verified disappearance of the pulmonary cyst. The cyst was speculated to be caused by a check valve mechanism, which may also suggest a rapid growth of the tumour. At the time of writing, 2 years post‐operatively, no tumour recurrence has been identified. This represents the first report of intrathoracic giant DSFT with a cystic lesion returning to normal lung parenchyma., A 65‐year‐old woman was brought to the emergency unit with an approximately 6‐month history of persistent fever and cough. Chest computed tomography demonstrated a 16‐cm heterogeneous mass with adjacent large cyst. The tumour was successfully resected, and the final diagnosis was dedifferentiated solitary fibrous tumour.

Vanishing lung syndrome (VLS) or idiopathic bullous emphysema is a rare condition often mimicking pneumothorax on chest radiograph. The condition frequently involves young male smokers and has been found to be associated with Marfan’s syndrome, alpha-1 antitrypsin deficiency, and marijuana abuse. We describe the case of a 70-year-old chronic smoker, who presented with acute dyspnea, chest pain, and cough and had a mystifying chest radiograph of pneumothorax. An urgent chest CT revealed giant bullae in the upper lobes of both lungs. After a brief symptomatic improvement with conservative management, we had to resort to surgery given the patient’s deteriorating pulmonary function. Giant bullae can be often misdiagnosed on chest radiograph as pneumothorax, inadvertent treatment of which can lead to dismal outcome like bullous rupture and iatrogenic pneumothorax. This case highlights the clinico-radiological profile and the management of VLS with special emphasis on the utility of emergency chest computed tomogram (CT) in highly suspicious scenarios.

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

Vanishing lung syndrome (VLS) is also referred to as idiopathic giant bullous emphysema and is a rare manifestation of chronic obstructive pulmonary disease (COPD). Middle-aged tobacco smokers, younger marijuana users, and those with alpha-1-antitrypsin deficiency may especially be affected. The clinical and radiographic findings of VLS may initially be misinterpreted as spontaneous pneumothorax. High-resolution CT is the diagnostic imaging modality of choice in these patients and can help to differentiate VLS from pneumothorax. Such imaging also helps guide appropriate management. Management of VLS ranges from a conservative to a surgical approach depending upon patients' comorbidities and candidacy for surgical resection. We present a case of a 64-year-old man with frequent hospitalizations for COPD exacerbation admitted with worsening shortness of breath and was found to have giant bullae mimicking a pneumothorax on the initial presentation.

Background Volume reduction surgery is a routine treatment method for lung emphysema in chronic obstructive pulmonary disease (COPD) patients. The formation of giant bullous emphysema is an indication for surgical bullectomy. Bilateral giant bullae severely compromise lung function and complicate surgical treatment. Case presentation We present the algorithm for surgical treatment and correction of complications in a 38-year-old male with bilateral giant bullae (vanishing lung syndrome), severe COPD. Primarily the patient was admitted with a mild cough, mucopurulent sputum and dyspnea. A CT scan revealed bilateral giant bullae, displacing up to 50% of lung volume. A two-stage surgical bullectomy was planned, yet postoperative complications due to secondary bullae rupture prompted urgent revision with contralateral bullae resection. After complete bullectomy, severely reduced lung volume was successfully managed throughout a long postoperative rehabilitation period. At 5 year follow-up, spirometry indicators and radiological examination show significantly improved and stable lung function. Conclusion This clinical case demonstrates the technical difficulties and possible complications of extended bilateral lung resections in patients with severe vanishing lung syndrome. Single-stage treatment of bilateral giant bullous emphysema is recommended to minimize postoperative complications and reduce risk of bullae rupture. Positive long-term outcome outweighs possible complications of surgical treatment.

Introduction: Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s) are infrequent, but widely recognized entities. Case report: A 80-years-old woman affected by progressive dyspnea over the previous three months, with productive cough. She was treated hypertension and had a pace maker implanted due to bradycardia. Chest X ray has shown right side pneumonia with high positive inflammatory markers. After resolution of pneumonia, phantom tumor of the lung was revealed, which disappear with intensive loop diuretics. Conclusions: The diagnosis of the phantom tumor ought to be pondered as a possibility in any patient with congestive heart failure and lung mass. The patient at hand featured no prior history of congestive heart failure, hence indicating that phantom tumor may occur in non-chronic heart failure patients. Albeid the reliable diagnosis of the phantom tumor through the utilization of imaging modalities in patients without congestive heart failure can be rather challenging, such possibility must be considered in a patient with a lung mass in the major fissure of the lungs. Due to accelerated expansion of the geriatric population and subsequent spread of the congestive heart failure, a rise in the incidence of vanishing tumors of the lung may be anticipated.

Vanishing lung syndrome is a clinical presentation of giant bullous emphysema associated with significant morbidity and mortality. We present a case of a 50-year-old white woman with vanishing lung syndrome who presented with a spontaneous secondary pneumothorax and an uncontrolled bronchopleural fistula. The large bronchopleural fistula was initially controlled with a double-lumen endotracheal tube and a tube thoracostomy. After surgical efforts failed, complete left lung isolation was performed with multiple intrabronchial valves. In essence, a medical pneumonectomy was performed. The patient was weaned from mechanical ventilation and discharged to rehabilitation. She was ambulatory at 5-month follow-up.

Highlights • The authors present a unique case of giant bullous emphysema in the context of a trauma evaluation. • During initial trauma evaluation giant bullous emphysema can be misdiagnosed as pneumothorax. • A computerized tomography scan can avoid catastrophic complications in patients with giant bullous emphysema, such as uncontrollable airway fistulas., Introduction: Giant bullous emphysema (GBE) is defined by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding parenchyma [1]. Symptoms include dyspnea, hypoxia, chest pain and pressure, and hemoptysis [2], which can be complicated by pneumothorax and infection of the bullae [3]. Case presentation: A 50-year-old male was brought to the emergency department after he fell 5 m in a suicide attempt. The patient was in respiratory distress and had bilateral absence of breath sounds. He was intubated and bilateral chest tubes were inserted. A computerized tomography (CT) scan showed bilateral giant bullous emphysema in the upper lobes, confirming a diagnosis of GBE. As a result of the insertion of chest tubes, he developed bilateral high flow fistulas. During his hospitalization, he developed sepsis secondary to ventilator-associated pneumonia. In an attempt to control the fistulas, a right bullectomy was performed. Despite antibiotic treatment and surgical intervention, the patient died due to septic shock. Discussion: The clinical picture of a patient with GBE can be similar to that of pneumothorax, and GBE has been reported as being misdiagnosed as pneumothorax [4,5]. A CT scan can play an important role in differentiating these conditions [6], thus avoiding needle decompression, which can be catastrophic [6]. Conclusion: Giant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement.

Rationale: The three classic emphysema subtypes were initially defined in small autopsy series. We used unsupervised machine learning to discover spatial lung texture patterns (sLTPs) to yield novel emphysema subtypes in a large study and examined their clinical significance. Methods: The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) recruited 2,981 smokers with or without COPD and nonsmoking controls who underwent standardized CT scans. We divided the study randomly into two learning sets and sampled lung regions of interest (ROIs) with percent emphysema-950HU>ULN. Texture features based on textons and spatial features were generated for individual ROIs and clustered via fusing feature distances. Graph partitioning was used to group clusters and generate sLTPs. Clustered sLTPs were collapsed additively. Linear regression adjusted for age, sex, race/ethnicity, smoking, pack-years, COPD, FEV1 and %emphysema. Results: Participants were age 63±9 years, 53% male and had 43±39 packyears; 63% had COPD. Ten distinct sLTPs were discovered in each training set. Inter-learner reproducibility was high: regional dice: 0.85, %sLTP r>0.95. Two pairs of sLTPs and three others clustered regionally and visually and were collapsed. The resultant six novel emphysema subtypes were all associated with respiratory symptoms. Visually, one resembled vanishing lung syndrome, three, non-standard emphysema and two, combined pulmonary fibrosis/emphysema (CPFE). All but one were associated with smoking and COPD; the exception (CPFE) had reduced FVC. Conclusion: Unsupervised machine learning of emphysema-like patterns was highly reproducible and appears to have yielded six novel emphysema subtypes.

Infective endocarditis is a major cause of morbidity and mortality among individuals with opioid use disorder who use injection drugs. It is frequently associated with tricuspid valve endocarditis and Staphylococcus aureus bacteremia, with secondary pulmonary septic emboli. Herein, we report a unique case of pulmonary cavitation injury following pulmonary septic emboli in the setting of tricuspid valve endocarditis in an injection drug user with opioid use disorder. The pattern of cavitary lung injury mimics radiographically indistinguishable features from vanishing lung syndrome during the most advanced stage of her illness. .

Giant bullous emphysema is an uncommon condition characterised by large asymmetric bullae with upper lobe predominance. This condition is most frequent in young male smokers. Patients usually present with progressive breathlessness which is secondary to enlargement of the bullae leading to compression of the lung parenchyma. Large asymmetrical bullae may appear as a unilateral hyperlucency on a plain chest radiograph, and may mimic the appearances of pneumothorax. A computed tomography scan is needed to delineate the lung pathology. We describe two cases with this condition that presented acutely and discuss the management of bullous emphysema.

Localized interlobular effusion, vanishing lung tumor or phantom tumor is a rare but well-known entity in heart failure patients. The loop diuretic which results in the reduction of the fluid burden, is completely disappear. Considering the diagnosis of phantom tumor prevents unnecessary, expensive and possibly harmful diagnostic and treatment errors.

A 48-year-old woman with medical history significant for 20 pack-years of smoking presented with decreased exercise tolerance for the last year. On examination, her respiratory rate was 18 and oxygen saturation was 96% on room air with absent breath sounds within the left lung field. Alpha-1 antitrypsin levels were normal. Chest radiograph revealed giant emphysematous bulla with concern for concurrent pneumothorax (figure 1). CT scan of the chest revealed a massive bulla without a ‘double wall sign’ making superimposed pneumothorax unlikely (figure 2). Chest tube insertion was deferred and patient underwent bullectomy. Prior to surgery, her exercise tolerance …

Very little information is known about patients with chronic obstructive pulmonary disease who travel to high altitude for work or pleasure. Even less is known about the outcomes at high altitude for patients with severe bullous lung disease. We present the case of a 54-yr-old man with vanishing lung syndrome, an idiopathic form of severe bullous emphysema, who has made repeated trips to altitudes as high as 3400 m, where he has engaged in physical activity, such as downhill skiing. We consider the issues of adequacy of oxygenation and the risks of barotrauma in patients with obstructive lung disease traveling to high altitude, and we also consider factors, such as improved air-flow limitation, maintenance of adequate ventilation-perfusion matching, and underlying physical fitness, which may affect our patient's ability to tolerate physical activity in this environment. The case demonstrates that the presence of severe lung disease does not necessarily preclude travel to and moderate activity at high altitude. Such travel may, in fact, be safe as long as the patient has undergone appropriate pretravel evaluation, and we provide recommendations regarding such evaluation in patients with chronic obstructive pulmonary disease.

Alternating or phasic ECG voltage changes are most commonly associated with intrinsic myocardial electrophysiological perturbations or mechanical oscillation within a pericardial effusion. Rare descriptions of electrical alternation have been reported with pneumothorax. We present a case of a 53-year-old woman with vanishing lung syndrome who presented with spontaneous left pneumothorax and phasic ECG voltage changes that resolved after re-expansion of the lung.

A previously healthy 34-year-old man attended the medical outpatient ward with a 6-month history of shortness of breath, which was worse on exertion. The patient was a chronic smoker but there was no additional history of cough, sputum production, haemoptysis, fever or chest pain. On examination

Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking.

We reviewed the imaging findings in nine patients with idiopathic giant bullous emphysema. This progressive condition is characterized by large bullae, usually seen in association with several forms of emphysema, and usually occurs in young men, most of whom are smokers.Nine patients with chest radiographic evidence of a bulla or bullae occupying at least one third of a hemithorax, who had also been examined with high-resolution CT, were included in this retrospective study. We examined the size, distribution, and locations of bullae. On high-resolution CT scans, bullae were categorized as predominantly subpleural or intraparenchymal.In eight of the nine cases, the chest radiographs showed variable asymmetry in the distribution of bullae. Bullous disease involved predominantly the upper lobes. High-resolution CT showed bullae from 1 to 20 cm in diameter, but most were 2-8 cm in diameter. Paraseptal emphysema and subpleural bullae were the predominant findings in all nine patients. Seven patients had separate centrilobular emphysema of various degrees and intraparenchymal bullae. None of the intraparenchymal bullae were larger than 2-3 cm. Additionally, two non-small-cell lung cancers were seen in our series.The dominant and consistent feature seen on high-resolution CT scans in both smokers and nonsmokers is extensive paraseptal emphysema merging into giant bullae. Associated centrilobular emphysema, seen in cigarette smokers, is the important variable finding for determining the extent of underlying parenchymal disease, which may help in the preoperative assessment of giant bullous lung disease.

In patients with a hyperlucent lung, radiological differentiation between a pneumothorax and a giant bulla is not always definitive. This may result in a chest tube insertion into a pulmonary bulla with devastating results or a delay in initiating appropriate treatment for pneumothorax. Usually, distinctions between the pleural line of a pneumothorax and the bulla wall can be made by computed tomography (CT). In addition, the double wall sign of pneumothorax (parallel bulla wall and chest wall outlined by air outside the bulla) is useful in recognising the coexistence of bullae and pneumothoraces.1 Here we report a case of vanishing lung syndrome, which was diagnosed by CT in a man who presented with sudden onset of …

We describe here a rare case of Idiopathic Bullous Emphysema/Vanishing Lung Syndrome (VLS) in a 33-year-old male patient with a history of marijuana abuse who presents to the hospital with pleuritic chest pain thought to be due to pneumothorax based on the chest radiograph. This case emphasizes the need to obtain chest computed tomography in a relatively stable patient suspected of VLS to reduce the potential risk of overseeing a bronchopleural fistula.

A 41-year-old man with a smoking history of 30 pack-years presented with chronic chest pain, dyspnea, and cough. Physical examination revealed cachexia, with decreased apical breath sounds and hyperresonance to percussion in both lungs.

A 44-year-old male smoker presented with acute shortness of breath. The patient's vital signs were stable and his oxygen saturation was 87% at room air. A chest X-ray (CXR) showed bilateral apical hyperlucencies diagnosed as bilateral spontaneous pneumothorax (figure 1). He underwent bilateral16-French chest tubes placement. Follow-up CXR failed to show improvement (figure 2). A chest CT scan was performed and showed bilateral large bullae consistent with vanishing lung syndrome (VLS) (figure 3). The patient underwent a video-assisted thoracoscopy and bullectomy (figure 4). Figure 1 Close-up view of the admission chest X-ray showing …

A 44-year-old man with a 20 pack-year history of smoking presented to the emergency department following a few hours of chest tightness, shortness of breath and cold sweats. He was tachypneic and had no breath sounds over his right hemithorax, which was hyperresonant to percussion. Arterial blood

The results of changes in dyspnea and pulmonary function are reported in 27 emphysematous patients followed up for about 10 years after removal of giant bullae, which occupied at least 50% of a hemithorax. In 10 patients bilateral bullectomy was done. The spirographic improvement depends on the type of bulla. Resection of bullae at open communication with the bronchial tree resulted predominantly in improvement of forced expiratory volume as a percentage of vital capacity, whereas after closed bullae were resected, the increase in vital capacity was most apparent. Dyspnea lessened in all patients. Seven older patients died of ventilatory insufficiency. Preoperatively they were clinically and functionally severely disabled. They improved markedly after bullectomy, and their mean survival time was more than 7 years. In all 27 patients improvement of dyspnea and pulmonary function lasted several years and only gradually returned to preoperative values and beyond. No giant bullae recurred in the observation period; neither was there an accelerated progression of the emphysematous process. Our present selection criteria, based on previous experience, are as follows: giant bullae occupying at least 50% of a hemithorax, definite displacement of adjacent lung tissue, exclusion of the presence of vanishing lung syndrome, and absence of chronic purulent bronchitis.

Two patients are reported with ‘vanishing lungs’ associated with sarcoidosis or necrotizing sarcoid granulomatosis. This syndrome is a rare outcome of sarcoidosis, but sarcoidosis may be an underlying cause of giant bullous emphysema. If bullectomy is undertaken, tissue should be removed from relatively normal lungs and mediastinal nodes to demonstrate the presence and nature of any granulomas.

BULLOUS emphysema is usually associated with strictures of the bronchi. These narrowed bronchi permit the inspired air to enter the alveoli, but on expiration the outlet closes and back-pressure is created, a mechanism which in time causes dilatation, atrophy, and rupture of the alveoli. Finally, large emphysematous bullae evolve from the coalescing alveoli. The histopathology of blebs and bullae has been described by W. S. Miller (1, 2). The etiology of the obstruction in bullous emphysema is frequently obscure. Presumably in some instances the bronchial changes are the result of developmental errors; in others, pulmonary fibrosis of unknown etiology such as described by Hampton (3) may be the cause. The best understood type is that in which bullae follow localized productive changes such as result from tuberculosis. Haymaker and Karan (4), and Freedman (5) have reported examples of the latter type. The diagnosis, made largely from the x-ray examination, may be confused with partial pneumothorax, cystic dis...

An unsuspected relationship between chemotherapy and "vanishing lungs" is now attracting much attention in centers devoted to treatment of pulmonary diseases. Perhaps the simplest way of describing this phenomenon is to say that pulmonary processes resolving under the effect of chemotherapy leave in their wake thin-walled abnormal air spaces now commonly designated as "cyst-like cavities." These have also been described as "vanishing lungs," a truly descriptive name. This remarkable phenomenon has been reported from many places and described uniformly as a new development in pulmonary pathology, raising questions of practical as well as theoretical nature. Practically, are we dealing with a new development? I definitely believe not. Even before chemotherapy was practiced, numerous observations were reported of vanishing lung areas affected by a variety of pulmonary processes; however, there is no doubt but that the incidence has greatly increased in recent years. It has also become apparent that more complete