Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Abrupt Bulla Formation by Visceral Pleural Detachment after Pulmonary Lobectomy: A Case Report

  • Byeong A Yoo (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seungmo Yoo (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae Kwang Yun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sehoon Choi (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.11.23
  • Accepted : 2022.12.06
  • Published : 2023.05.05
Download PDF
⟨ Previous Next ⟩

Abstract

Pulmonary bullae usually grow slowly and have thin walls. However, we have observed 2 cases of abrupt bulla formation immediately after lobectomy and during surgery. The pathologic findings of what can be called visceral pleural detachment are quite distinctive: these bullae had a broad base connected to the lung, and their walls were thick, including the full extent of visceral pleural and peripheral alveolar tissues, which suggests that the visceral pleura were detached from the distal alveoli. High transpleural pressure might be the key factor in the pathogenesis of this type of bulla, unlike previously known types of bullous lung disease.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

References

  1. Klingman RR, Angelillo VA, DeMeester TR. Cystic and bullous lung disease. Ann Thorac Surg 1991;52:576-80. https://doi.org/10.1016/ 0003-4975(91)90939-n 
  2. Martinez FJ. Bullous disease of the lung. In: Grippi MA, Elias JA, Fishman JA, et al. Fishman's pulmonary diseases and disorders. 5th ed. New York (NY): McGraw-Hill; 2015. p. 787-99. 
  3. Morgan MD, Edwards CW, Morris J, Matthews HR. Origin and behaviour of emphysematous bullae. Thorax 1989;44:533-8. https:// doi.org/10.1136/thx.44.7.533 
  4. Morgan MD, Denison DM, Strickland B. Value of computed tomography for selecting patients with bullous lung disease for surgery. Thorax 1986;41:855-62. https://doi.org/10.1136/thx.41.11.855 
  5. Bok JS, Lee GD, Kim DK, Lim D, Joo SK, Choi S. Changes of pleural pressure after thoracic surgery. J Thorac Dis 2018;10:4109-17. https://doi.org/10.21037/jtd.2018.06.131 
  6. Kondo Y, Nakao M, Hashimoto K, et al. Two cases of lower lobe pneumatoceles following upper lobectomy. Ann Thorac Surg 2021; 112:e403-6. https://doi.org/10.1016/j.athoracsur.2021.02.081 
  7. Sugimura A, Takahashi T, Sekihara K, Nagasaka S. Case of rapid formation of intraoperative pulmonary pneumatocele after lobectomy. Ann Thorac Surg 2020;110:e331-2. https://doi.org/10.1016/j.athoracsur.2020.03.028