ONLINE IMAGES IN THE MEDICAL SCIENCES Vanishing Lung Syndrome of Uncommon Size

The authors have no financial or other conflicts of interest to disclose. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. CLINICAL PRESENTATION A 48-year-old female nonsmoker was admitted to our hospitalwith a 10-year history of chronic chest tightness and dysp-nea. Physical examination revealed decreased breath sounds and hyperresonance to percussion in left lung. Chest x-ray showed a hyperlucent left hemithorax with a severe rightward medias-tinal shift, which was suggestive of tension pneumothorax. But high-resolution computed tomography of the chest revealed that several giant bullae occupying almost the entire left hemithorax with severe mediastinal displacement to the right (Figure 1), which was consistent with vanishing lung syndrome. This patient successfully underwent video-assisted thoracoscopic resection of the left giant bullae and is currently without resid-ual symptoms. Vanishing lung syndrome, also termed idiopathic giant bullous emphysema, is a progressive bullous disease that often occurs in young male smokers.1 Roberts et al2 proposed the radiographic criteria that include giant bullae in 1 or both upper lobes occupying at least one-third of the hemithorax and com-pressing the surrounding parenchyma. High-resolution com-puted tomography plays an important role in differentiating giant bullae from tension pneumothorax. Bullectomy is the treatment of choice for patients presenting with dyspnea and giant bullae. We report a successful resection of giant bullae by means of video-assisted thoracic surgery, even when giant bul-lae occupied the entire hemithorax, and residual lung remained a collapsed state for a long period