Darlyn Victor, MD, Paul Moots, MD and Jacqueline Fischer, MD
October 13, 2016
A 39-year-old African-American male with a 15-pack year tobacco smoking history and intermittent marijuana use was admitted with complaints of sudden-onset chest pain, progressive dyspnea, and diaphoresis. He was initially hypoxic with a peripheral oxygen saturation of 89%, requiring 4 L/min of supplemental oxygen. Complete blood count was remarkable for leukocytosis of 23.03 103/μL. Comprehensive metabolic panel, cardiac enzymes, and electrocardiogram were unremarkable. Chest X-ray revealed severe bullous emphysematous changes with basilar opacities (See Figure 1). Given the extent of bullous disease, high-resolution CT scan was obtained, which demonstrated multiple bullae, with the two largest measuring 11 cm x 5 cm in the left upper lobe (See Figure 2) and 8.8 cm x 6 cm in the right upper lobe (not shown). Pulmonary function testing and α1-antitrypsin results were within normal limits.
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References:
1. L. Roberts, C. E. Putman, et al., “Vanishing lung syndrome: upper lobe bullous pneumopathy,” Revista Interamericana de Radiología, vol. 12, pp. 249–255, 1987.
2. N. Sharma, A. M. Justaniah, J. P. Kanne, J. W. Gurney, and T. L. H. Mohammed, “Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review,” Journal of Thoracic Imaging, vol. 24, no. 3, pp. 227–230, 2009.
Authors:
1. Darlyn Victor, MD, is a third-year Internal Medicine resident at the University of Illinois College of Medicine at Peoria in Peoria, Illinois.
2. Paul Moots, MD, is a third-year Internal Medicine resident at the University of Illinois College of Medicine at Peoria in Peoria, Illinois.
3. Jacqueline Fischer, MD, is an Associate Clinical Professor and Academic Hospitalist at the University of Illinois College of Medicine at Peoria in Peoria, Illinois.