We have performed 253 thoracotomies among a total of 334 cases of spontaneous pneumothorax during the past 17 years, subjecting 126 of these surgical cases to histologic examination by light microscope. Recently, we have classified 54 emphysematous bullae as Reid type 1 or 2 and have examined these, as well as giant bullae, by scanning electron microscope. This revealed exterior surface differe...

Background: Bullectomy is preferred for the treatment of giant emphysematous bulla (GEB). For the surgically unfit candidates, bronchoscopic placement of one-way endobronchial valve (EBV) and intracavitary drainage of bulla have been considered as alternative strategies. Case presentation: In this report, we present a surgery unfit patient with giant emphysematous bulla in the left lower lobe w...

Swyer-James syndrome was first described in 1953 as unilateral pulmonary emphysema in a 6-year-old boy. The characteristic feature of this syndrome is unilateral pulmonary hyperlucency on a chest X-ray film. Typical symptoms include recurrent chest infections, chronic cough, wheezing, and exertional dyspnea. Although there have been a few reports of pneumothorax in patients with Swyer-James syn...

Emphysematous bullae are closed air containing spaces in lung parenchyma that may severely compromise lung function in patients of chronic obstructive pulmonary disease (COPD). We describe a simple and minimally invasive procedure to decompress a large emphysematous bullae in a patient with advanced COPD and high surgical risk. Transthoracic decompression of the bulla was accomplished under sho...

In a 64-year-old ventilated patient with severe chronic obstructive pulmonary disease and extensive unilateral pneumonia, intrinsic PEEP became recognized when the chest roentgenogram showed unilateral lung hyperinflation and herniation of a large bulla to the contralateral hemithorax. The use of an on-line suction catheter may have contributed to the development of intrinsic PEEP. Removal of t...

Paratracheal air cysts are collections of air adjacent to the trachea. These lesions are usually an incidental finding at routine chest computed tomography (CT) scan, and their frequency is probably underestimated, because almost all patients are asymptomatic.1 Differential diagnosis of paratracheal air cysts includes tracheal diverticulum, pharyngocele, laryngocele, Zenker diverticulum, apical...

Two patients were admitted to our hospital due to giant bullae. During thoracoscopic surgery, saline-cooled radiofrequency coagulation devices were used to shrink the wall of the bulla. In each case, the volume of the bulla was gradually reduced and the boundary between the lung and bulla was clearly delineated. This method is considered to be useful for performing thoracoscopic surgery of gian...