Surgical treatment of bilateral vanishing lung syndrome: a case report

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.