Dr. Lawrence presented a case today of a patient with a 50+ pack-year smoking history with concern for bowel obstruction and need for surgery – imaging showed very significant bulla.
What might you recommend before the surgical procedure?
- Optimization of medication (referred to COPD clinic)
- Smoking cessation
- PFTs (points were brought up about not using DLCO/VA, though might be helpful to compare to TLC; and N2 washout suboptimal in patient with obstruction)
Bullous emphysema – giant bulla is >1cm in diameter and giant bulla occupies at least 30% of hemothorax
Example from online:
Management varies – bullectomy sometimes but practices varies across institution.
Thanks for sharing, Dr. Lawrence!
