Vanishing lung syndrome mistaken for bilateral spontaneous pneumothorax.

To cite: Khasawneh FA, Nakhla EN, Karim A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201016 DESCRIPTION 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). VLS or giant bullous emphysema, is a progressive bullous disease characterised by large bullae that involve at least one-third of one or both hemithorax. In VLS, paraseptal emphysema coalesces to form giant bullae. The formation of these intrathoracic spaces, and under influence of lung elastic recoil, causes healthy parenchyma to collapse rearranging itself to a lower expansion state.