Search Results (3)

Background and Clinical Significance: Heated tobacco products (HTPs) are a re-emerging class of tobacco products that present themselves as alternatives to conventional cigarettes with reduced risks. However, recent evidence has shown potential association with lung injury. We present a case of a pulmonary complication associated with use of IQOS, a popular HTP, contributing to the growing evidence of its risks. Case Presentation: A 22-year-old man presented with sharp right posterior thoracic pain, antalgic dyspnea, chills which developed suddenly in the morning, and fever. He had no past medical history. He had been a conventional smoker for 2 years (1 pack-year) but had switched to IQOS for the previous 4 years. A thoracic X-ray examination showed a big emphysematous bulla, about 84/60 mm, located in the right middle pulmonary lobe. A thoracic CT scan described a cyst of 77/84/62 mm with hydroaeric level in the right lobe and another emphysema bulla of 11 mm in the inferior right lobe. A differential diagnosis was performed, and autoimmune diseases, tuberculosis and viral infections were excluded. Alpha-1 antitrypsin level was normal. Blood culture was positive for Pseudomonas aeruginosa. After 4 weeks of antibiotic therapy, the infection was cured. Surgery was necessary for pleuro-pulmonary release with division of adhesions of the giant bulla. Conclusions: Case reports of pulmonary injury associated with IQOS use need to be published, contributing to a better understanding of the product’s toxicity and health impact. Full article

Background: Emphysema is a chronic lung disease characterized by alveolar wall destruction, leading to impaired gas exchange. Giant bullous emphysema (GBE) is a severe form of emphysema, often requiring surgical intervention. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for various thoracic pathologies, including lung volume reduction surgery (LVRS) and bullectomy for emphysematous bullae. Uniportal VATS (U–VATS), a further refinement, offers benefits such as reduced postoperative pain and faster recovery. Methods: This retrospective study analyzed data from two high-volume European Thoracic Surgery centers between August 2016 to January 2024. A total of 29 patients underwent U–VATS bullectomy for GBE. Results: Nineteen patients were males (65.5%) with a mean age of 44.7 ± 8.8 years. Ten (34.5%) were active smokers. Eighteen patients (62.1%) presented with a single giant bulla, while the remaining cases were in the context of pulmonary emphysema. Four patients (13.8%) presented with pneumothorax, with one requiring preoperative chest drainage. Twenty-eight patients (96.6%) underwent only U–VATS bullectomy, with additional chemical pleurodesis in eleven cases (37.9%). One patient (3.4%) underwent a left upper lobectomy for a giant bulla and NSCLC. In cases of severe lung emphysema and fragile pulmonary tissue, the stapler line was buttressed with Gore^® Seamguard^®. No conversions to thoracotomy, postoperative air-leaks, or major complications were recorded. At a mean follow-up time of 22.0 ± 14.0 months, no pneumothorax recurrence was documented. At about six months after surgery, pulmonary function significantly improved. Conclusions: U–VATS bullectomy appears to be a safe and feasible technique for the treatment of bullae in GBE, offering promising postoperative outcomes. Full article

Background and Objectives: Giant bullae rupture easily and cause tension pneumothorax, which can cause problems during general anesthesia. However, the hemodynamic instability that can occur due to the mass effect of an unruptured giant bulla should not be overlooked. Case report: A 43-year-old male patient visited the emergency room with an abdominal wound. There was a giant emphysematous bulla in the left lung. Emergency surgery was decided upon because there was active bleeding according to abdominal CT. After tracheal intubation, the patient’s blood pressure and pulse rate dramatically decreased. His blood pressure did not recover despite the use of vasopressors and discontinuation of positive pressure ventilation applied to the lungs. Thus, a bullectomy was immediately performed. The patient’s blood pressure and pulse rate were normalized after the bullectomy. Conclusions: If emergency surgery under general anesthesia is required in a patient with a giant emphysematous bulla, it is safe to minimize positive pressure ventilation and remove the giant emphysematous bulla as soon as possible before proceeding with the remainder of the surgery. Tension pneumothorax due to the rupturing of a bulla should be considered first. However, hemodynamic changes might occur due to the mass effect caused by a giant bulla. Full article