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Miðaldra reykingamaður með risablöðru í lunga : sjúkratilfelli

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Authors
Hilmir Ásgeirsson
Dóra Lúðvíksdóttir
Ólafur Kjartansson
Tómas Guðbjartsson
Issue Date
2008-10-01

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Other Titles
A 49 year old male with a giant pulmonary bulla--a case report and review of the literature
Citation
Læknablaðið 2008, 94(10):673-7
Abstract
A 49 year old previously healthy smoker was diagnosed with a giant bulla in his right lung, following a history of dry cough, repeated upper airway infections and increasing dyspnea for several years. Computed tomography (CT) confirmed the presence of a giant bulla in the right inferior lobe and several smaller bullae in the right superior lobe. The giant bulla was 17 cm in diameter, occupying more than half of the right hemithorax. On spirometry a moderate restrictive and a mild obstructive pattern was observed. Lung volume was measured with two different techniques, nitrogen washout and plethysmography, with volume of the bullae estimated at 2.9 L, similar to the 3.2 L determined by CT. The patient underwent thoracotomy, where the giant bulla together with the inferior lobe were removed with lobectomy and the small bullae in the superior lobe with wedge resection. Five months postoperatively the patient is in good health and is back at work. Postoperatively significant improvements in spirometry values and lung volume measurements have been documented. This case demonstrates that giant bullae can be successfully managed with surgical resection and their size can be determined by different techniques, including lung volume measurements and chest CT.
Hraustur 49 ára gamall reykingamaður var greindur með risastóra blöðru í hægra lunga. Hann hafði við greiningu þriggja mánaða sögu um þurran hósta og endurteknar efri loftvegasýkingar ásamt nokkurra ára sögu um hægt vaxandi mæði. Á tölvusneiðmynd sást risablaðra í neðra lungnablaði og minni blöðrur miðlægt í efra blaði. Risablaðran var 17 cm í þvermál og náði yfir meira en helming lungans. Samanlagt rúmmál blaðranna mældist 3,2 lítrar á tölvusneiðmyndum. Einnig voru gerðar lungnarúmmálsmælingar með tveimur mismunandi aðferðum (köfnunarefnistæmingu og þrýstingsaðferð) og rúmmál blaðranna þannig áætlað 2,9 lítrar. Öndunarmæling sýndi talsverða herpu. Ákveðið var að gera brjóstholsskurðaðgerð og var risablaðran fjarlægð með blaðnámi og blöðrurnar í efra blaði með fleygskurði. Eftir aðgerð mældist marktæk aukning á fráblástursrúmmáli. Fimm mánuðum eftir aðgerð er sjúklingurinn við góða heilsu og er aftur kominn til vinnu. Þetta tilfelli sýnir að hægt er að fjarlægja risablöðrur úr lunga með skurðaðgerð og hægt er að áætla rúmmál blaðranna með bæði myndgreiningarrannsóknum og öndunarmælingum.
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