A Rare Case of Vanishing Lung Syndrome: Should We Rely Only on Radiographs for Deciding Management?

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.