Klīniskais gadījums: idiopātiska gigantiska bulloza emfizēma
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Gigantiska bulloza emfizēma (“izzūdošās” plaušas sindroms) ir reta patoloģija, kas parasti ir raksturīga jauniem vīriešiem – smēķētājiem vai arī pacientiem ar α1-antitripsīna deficītu. Radioloģiskos izmeklējumos bullas izmēriem ir jābūt vismaz 30% no plaušas attiecīgajā pusē, lai to varētu saukt par gigantisku. Tipiski šādiem pacientiem ir sūdzības par progresējošu elpas trūkumu, kas veidojas, bullai nospiežot apkārtējos plaušaudus un traucējot optimālai gāzu apmaiņai, bet nereti šādi pacienti var būt asimptomātiski un var nenojaust par esošo patoloģiju. Šis pacienta klīniskais gadījums ir par 36 gadus vecu vīrieti, ilgstošu smēķētāju, kuram gigantiska bulloza emfizēma pirmo reizi tika konstatēta kā gadījuma atradne, veicot krūškurvja un vēdera datortomogrāfiju stacionēšanas epizodes laikā, kuras iemesls bija akūts pankreatīts. Šīs epizodes laikā pacientam nebija nekādu respiratoro simptomu vai sūdzību un pēc veiksmīgas akūta pankreatīta terapijas pacients tika izrakstīts tālākai ambulatorai ārstēšanai. Konstatētās plaušu emfizēmas un bullozo izmaiņu dēļ pacients gadu nebija devies pie neviena ārsta, līdz pacients akūtā kārtā tika stacionēts pulmonoloģijas nodaļā. Pacientam šīs stacionēšanas reizē bija paaugstināta ķermeņa temperatūra, elpas trūkums un sāpes krūtīs. Tika veikta krūškurvja datortomogrāfija, kurā vizualizējas inficētas bullas ar gaisa-šķidruma līmeņiem kā sadzīvē iegūtas pneimonijas komplikācija. Pēc sekmīgas antibakteriālās terapijas pacients tika izrakstīts ar rekomendācijām tālākai torakālā ķirurga konsultācijai. Pēc pāris mēnešiem pacientam tika veikta video-asistēta torakoskopija un kreisās puses augšdaivas lobektomija kā definitīvā ārstēšanas metode. Pacients tika izrakstīts bez nepieciešamības regulārām pārbaudēm. Šis pacienta gadījums rāda, ka pat, ja slimība ir asimptomātiska un netraucē pacienta ikdienas aktivitātēm, ir svarīgi pievērst uzmanību šai patoloģijai un to novērot, lai izvairītos no tādām komplikācijām kā bullas inficēšanās vai bullas plīsums, kas var izraisīt totālu pneimotoraksu vai ar infekciju saistītas pacienta dzīvību apdraudošas komplikācijas.
Giant bullous emphysema (vanishing lung syndrome) is a rare condition that typically presents in young male smokers or α1-antitrypsin deficient patients. On chest radiograph, bulla has to take no less than 30% of hemithorax to be considered a giant bulla. Commonly such pa-tients present with progressive dyspnea due to the bulla compressing surrounding lung tissue and disturbing optimal gas exchange, but sometimes these patients can be asymptomatic and have no idea of the existing pathology. Presented in this case is a 36-year old male, long-term smoker, whose CT for abdomen and chest, which was performed while he was hospitalised due to acute pancreatitis, revealed giant bullous emphysema as an accidental finding. At the time when his first chest CT was obtained he was asymptomatic regarding his respiratory system and, after successful treatment of an acute pancreatitis, was discharged with recommendations for further ambulatory treatment. Regarding his lung emphysema and bullous changes he did not attend any physician for a year until he presented in a hospital’s emergency unit with fever, dyspnea and chest pain. He was admitted in a pulmonary department. Chest CT was performed and it revealed infected bullae containing air-fluid levels as a complication of community-acquired pneumonia. After successful antibacterial treatment, the patient was discharged with recommendations to have a consultation with thoracic surgeon. A few months later he had vid-eo-assisted thoracoscopic surgery for upper left lobectomy as definitive treatment. Patient was discharged without requirements for further follow-ups. This case shows that even though the disease is asymptomatic and may not disturb daily activities of the patient, it is important to pay attention to this pathology and follow-up to avoid possible complications such as infection of the bullae or rupture of bullae, causing total pneumothorax or infection-linked life-threatening conditions.
Giant bullous emphysema (vanishing lung syndrome) is a rare condition that typically presents in young male smokers or α1-antitrypsin deficient patients. On chest radiograph, bulla has to take no less than 30% of hemithorax to be considered a giant bulla. Commonly such pa-tients present with progressive dyspnea due to the bulla compressing surrounding lung tissue and disturbing optimal gas exchange, but sometimes these patients can be asymptomatic and have no idea of the existing pathology. Presented in this case is a 36-year old male, long-term smoker, whose CT for abdomen and chest, which was performed while he was hospitalised due to acute pancreatitis, revealed giant bullous emphysema as an accidental finding. At the time when his first chest CT was obtained he was asymptomatic regarding his respiratory system and, after successful treatment of an acute pancreatitis, was discharged with recommendations for further ambulatory treatment. Regarding his lung emphysema and bullous changes he did not attend any physician for a year until he presented in a hospital’s emergency unit with fever, dyspnea and chest pain. He was admitted in a pulmonary department. Chest CT was performed and it revealed infected bullae containing air-fluid levels as a complication of community-acquired pneumonia. After successful antibacterial treatment, the patient was discharged with recommendations to have a consultation with thoracic surgeon. A few months later he had vid-eo-assisted thoracoscopic surgery for upper left lobectomy as definitive treatment. Patient was discharged without requirements for further follow-ups. This case shows that even though the disease is asymptomatic and may not disturb daily activities of the patient, it is important to pay attention to this pathology and follow-up to avoid possible complications such as infection of the bullae or rupture of bullae, causing total pneumothorax or infection-linked life-threatening conditions.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Emfizēma, bullas, gigantiska bulloza emfizēma, pacienta gadījums, Emphysema, bulla, giant bullous emhpysema, case report