Bullectomy

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Bullectomy
Bullous emphysema (4857852447).jpg
Cross section of Bullous emphysema

Bullectomy is a surgical procedure in which dilated air-spaces or bullae in lung parenchyma are removed. [1] Common causes of dilated air-spaces include chronic obstructive pulmonary disease and emphysema. Patients with giant bullae filling half the thoracic volume and compressing relatively normal adjacent parenchyma are recommended for bullectomy. [2] [3] It is also indicated in severe dyspnea, repeated respiratory infections and spontaneous pneumothorax. [4] The size of dilated air-spaces or bullae volume is the most important factor in relation to ventilator capacity post-bullectomy. In cases where the size of bullae are enlarged, bullectomy is indicated if the percentage of forced expiratory volume in one second(FEV1%) is greater than 40% and the regional ventilation over volume dynamic(V/V Dynamic) is greater than 0.5. [5] [6]

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A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is formed by an area of damaged tissue, and the amount of air in the space between chest wall and lungs increases; this is called a tension pneumothorax. This can cause a steadily worsening oxygen shortage and low blood pressure. This leads to a type of shock called obstructive shock, which can be fatal unless reversed. Very rarely, both lungs may be affected by a pneumothorax. It is often called a "collapsed lung", although that term may also refer to atelectasis.

<span class="mw-page-title-main">Pulmonology</span> Study of respiratory diseases

Pulmonology, pneumology or pneumonology is a medical specialty that deals with diseases involving the respiratory tract. It is also known as respirology, respiratory medicine, or chest medicine in some countries and areas.

<span class="mw-page-title-main">Cardiothoracic surgery</span> Medical specialty involved in surgical treatment of organs inside the thorax

Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.

<span class="mw-page-title-main">Chest tube</span> Type of surgical drain

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<span class="mw-page-title-main">Atelectasis</span> Collapse or closure of a lung resulting in reduced or absent gas exchange

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<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

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<span class="mw-page-title-main">Subcutaneous emphysema</span> Medical condition

Subcutaneous emphysema occurs when gas or air accumulates and seeps under the skin, where normally no gas should be present. Subcutaneous refers to the subcutaneous tissue, and emphysema refers to trapped air pockets resembling the pneumatosis seen in pulmonary emphysema. Since the air generally comes from the chest cavity, subcutaneous emphysema usually occurs around the upper torso, such as on the chest, neck, face, axillae and arms, where it is able to travel with little resistance along the loose connective tissue within the superficial fascia. Subcutaneous emphysema has a characteristic crackling-feel to the touch, a sensation that has been described as similar to touching warm Rice Krispies. This sensation of air under the skin is known as subcutaneous crepitation, a form of crepitus.

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<span class="mw-page-title-main">Chronic obstructive pulmonary disease</span> Lung disease involving long-term poor airflow

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Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces (pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli and they replace the spongy lung parenchyma. This reduces the total alveolar surface available for gas exchange leading to a reduction in oxygen supply for the blood. Emphysema usually affects the middle aged or older population because it takes time to develop with the effects of tobacco smoking, and other risk factors. Alpha-1 antitrypsin deficiency is a genetic risk factor that may lead to the condition presenting earlier.

<span class="mw-page-title-main">Focal lung pneumatosis</span> Medical condition

A focal lung pneumatosis, is an enclosed pocket of air or gas in the lung and includes blebs, bullae, pulmonary cysts, and lung cavities. Blebs and bullae can be classified by their wall thickness.

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References

  1. Petro, W.; Hübner, C.; Greschuchna, D.; Maassen, W.; Konietzko, N. (1 December 1983). "Bullectomy". The Thoracic and Cardiovascular Surgeon. 31 (6): 342–345. doi:10.1055/s-2007-1022015. PMID   6198753.
  2. Meyers BF, Patterson GA (July 2003). "Chronic obstructive pulmonary disease. 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease". Thorax. 58 (7): 634–8. doi:10.1136/thorax.58.7.634. PMC   1746734 . PMID   12832685.
  3. De Giacomo T, Rendina EA, Venuta F, Moretti M, Mercadante E, Mohsen I, Filice MJ, Coloni GF (September 2002). "Bullectomy is comparable to lung volume reduction in patients with end-stage emphysema". European Journal of Cardio-Thoracic Surgery. 22 (3): 357–62. doi: 10.1016/s1010-7940(02)00351-2 . PMID   12204723.
  4. Chung PH, Wong KK, Lan LC, Tam PK (September 2009). "Thoracoscopic bullectomy for primary spontaneous pneumothorax in pediatric patients". Pediatric Surgery International. 25 (9): 763–6. doi:10.1007/s00383-009-2432-9. PMID   19652983.
  5. Baldi S, Palla A, Mussi A, Falaschi F, Carrozzi L, Giuntini C, Angeletti CA (1 July 2001). "Influence of bulla volume on postbullectomy outcome" (PDF). Canadian Respiratory Journal. 8 (4): 233–8. doi: 10.1155/2001/479653 . PMID   11521138.
  6. Nakahara K, Nakaoka K, Ohno K, Monden Y, Maeda M, Masaoka A, Sawamura K, Kawashima Y (May 1983). "Functional indications for bullectomy of giant bulla". The Annals of Thoracic Surgery. 35 (5): 480–7. doi: 10.1016/s0003-4975(10)60419-5 . PMID   6847283.