Benign Lung Conditions IV

Author: Shelby Stewart, MD
Institution: University of Maryland
Date Reviewed: 2024
Original Case: Stephen C. Yang, MD
Learning Domain: General Thoracic
Learning Objective: Pneumonia, pulmonary sequestration
PowerPoint File: Benign Lung Conditions IV

Learning Goals

• The basic level concepts focused on:
  • Etiology of emphysema and bullae
  • Pathophysiology of emphysema and bullae
  • Indications for bullectomy
• The advanced level concepts focused on:
  • NETT Trial Part 1 & 2 of emphysema and bullae
  • Pulmonary rehabilitation of emphysema and bullae

Case #1 Discussion Points for Conference

• Differential diagnosis?
  • Pneumothorax
  • Giant Bullous emphysema
• Indications for surgery?
  • Symptoms (pneumothorax, dyspnea)
  • Bleeding (rare)
  • Infection (rare)
• Surgical approaches? (resection vs lesser invasive procedures)
  • VATS/ RATS approach preferred
  • Muscle sparing thoracotomy
  • Stapled wedge resection 
  • Formal lobectomy rarely necessary
  • Consider pleurectomy, pleural tent, pleurodesis
  • Consider staple reinforcement/buttress

Case #2 Discussion Points for Conference

• Next steps?
• Medical treatment and indications?
  • bullectomy
  • LVRS
  • Lung transplant
• Preoperative work up and management?
  • V/Q scan
  • Pulmonary rehab
  • 6 min walk test
  • ECHO

Learning Points

• Indications for resection of giant bulla and workup
• Preoperative medical therapies and strategies for patients with COPD and bullous emphysema
• Know which candidates improve with LVRS
• Surgical options for LVRS
• Complication postop of LVRS