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Abstract
Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and righthydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.
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References
- Batirel H.F, and Zellos Lambros (2015). 100: Minimally invasive Methods of Managing Giant Bullae: Mondaldi Procedure. In Sugarbaker D, Bueno R, Colson Y, Jaklitsch M, Krasna M, Mentzer S (eds). Adult chest surgery. 2nd ed. United States: McGraw-Hill
- Boddu, P., Parimi, V., Taddonio, M., Kane, J. and Yeldandi, A. (2017). Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review. Pathology Research International,1-17.
- Cosgrove, G., Frankel, S. and Brown, K. (2007). Challenges in pulmonary fibrosis . 3: Cystic lung disease. Thorax, 62(9),820-829.
- Garcia-Herreros L, Villamizar E, Salcedo D (2018). Trans"mediastinal herniation of pulmonary bulla with paradoxical pneumothorax. Journal of Surgical Case Reports
- Hasnain Fatimi, Saulat & Jafferani, Asif & Ashfaq, Awais (2012). Giant Pulmonary Bulla with Mediastinal Shift in a 12 1/2 year old girl. JPMA. The Journal of the Pakistan Medical Association, 62, 503-4.
- Im Y, Farooqi S, and Mora A (2016). Jr.Vanishing Lung Syndrome. Proc(Bayl Univ Med Cent), 29(4), 399-401
- Odev K, Ozbiner H, Pekcan S, Altinok T, Batur A, Guler I (2013). Cystic and Cavitary Lung Lesions in Children: Radiologic Findings with Pathologic Correlation. Journal of Clinical Imaging Science,3(1),60.
- Papiris S, Manali E, Kolilekas L, Kagouridis K, Maniati M, Borie R et al (2015). Investigation of Lung Involvement in Connective Tissue Disorders. Respiration, 90(1), 2-24.
- Ruan S, Huang C, Chien J, Kuo Y, Yu C (2011). Non-surgical Management of Giant Lung Bullae During Mechanical Ventilation. Respiratory Care, 56(10), 1614-1616.
- Schipper P, Meyers B, Battafarano R, Guthrie T, Patterson G, Cooper J (2004). Outcomes after resection of giant emphysematous bullae. The Annals of Thoracic Surgery,78(3), 976-982.
- Singh S, Singh N, Singh V (2015). Trans-mediastinal herniation of bulla: Semilunar sign. Lung India, 32(6), 611.
References
Batirel H.F, and Zellos Lambros (2015). 100: Minimally invasive Methods of Managing Giant Bullae: Mondaldi Procedure. In Sugarbaker D, Bueno R, Colson Y, Jaklitsch M, Krasna M, Mentzer S (eds). Adult chest surgery. 2nd ed. United States: McGraw-Hill
Boddu, P., Parimi, V., Taddonio, M., Kane, J. and Yeldandi, A. (2017). Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review. Pathology Research International,1-17.
Cosgrove, G., Frankel, S. and Brown, K. (2007). Challenges in pulmonary fibrosis . 3: Cystic lung disease. Thorax, 62(9),820-829.
Garcia-Herreros L, Villamizar E, Salcedo D (2018). Trans"mediastinal herniation of pulmonary bulla with paradoxical pneumothorax. Journal of Surgical Case Reports
Hasnain Fatimi, Saulat & Jafferani, Asif & Ashfaq, Awais (2012). Giant Pulmonary Bulla with Mediastinal Shift in a 12 1/2 year old girl. JPMA. The Journal of the Pakistan Medical Association, 62, 503-4.
Im Y, Farooqi S, and Mora A (2016). Jr.Vanishing Lung Syndrome. Proc(Bayl Univ Med Cent), 29(4), 399-401
Odev K, Ozbiner H, Pekcan S, Altinok T, Batur A, Guler I (2013). Cystic and Cavitary Lung Lesions in Children: Radiologic Findings with Pathologic Correlation. Journal of Clinical Imaging Science,3(1),60.
Papiris S, Manali E, Kolilekas L, Kagouridis K, Maniati M, Borie R et al (2015). Investigation of Lung Involvement in Connective Tissue Disorders. Respiration, 90(1), 2-24.
Ruan S, Huang C, Chien J, Kuo Y, Yu C (2011). Non-surgical Management of Giant Lung Bullae During Mechanical Ventilation. Respiratory Care, 56(10), 1614-1616.
Schipper P, Meyers B, Battafarano R, Guthrie T, Patterson G, Cooper J (2004). Outcomes after resection of giant emphysematous bullae. The Annals of Thoracic Surgery,78(3), 976-982.
Singh S, Singh N, Singh V (2015). Trans-mediastinal herniation of bulla: Semilunar sign. Lung India, 32(6), 611.