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1/2. Intracavitary drainage procedure for giant bullae in compromised patients.

    Two cases of giant bullae were treated by intracavitary suction and drainage procedure under local anesthesia because of the poor pulmonary function. After staged bullectomy, the patients returned to normal life. The first case was admitted to our intensive care unit (ICU). Tube drainage was performed in the giant bulla of the left lung immediately after admission. One month after recovery from right heart failure and mediastinal shift to the right side, bullectomy was performed using linear stapler. The patient was discharged 20 days later. The second case was admitted with severe dyspnea and bilateral giant bullae were noticed. We performed tube drainage for larger bulla of the left lung under local anesthesia. Two months later, bullectomy was performed on the right side, because the bulla on the left side became smaller and the general condition of the patient improved. The patient was discharged three months later on foot and has since been asymptomatic. Giant bulla is a well-established clinical entity which includes abnormal dilatation of various parts of the tracheo-bronchial tree and other discrete sacs originating from the interstitial portion of the lung. Giant bullae are frequently associated with marked dyspnea and emphysematous symptoms. However, these symptoms depend upon various factors: size, location, valvular mechanism, condition of the contiguous lung parenchyma and the changes that may take place in the intrathoracic pressure.
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2/2. ventilation/perfusion mismatch caused by emphysematous bullae.

    A case of ventilation/perfusion mismatch caused by emphysematous bullae is presented. The presumed mechanism for the mismatch was vascular displacement of the pulmonary arterial tree by bullae with apparently normal ventilation. The latter may have been related to the circumferential distribution of the bullae around each lung. This entity represents an addition to the differential diagnostic list of causes of ventilation/perfusion mismatch on radionuclide lung images.
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