• Muhammad Shoaib Lodro
  • Tanveer Ahmad
  • Ambreen Abid



Giant bullae, Monaldi, Brompton, Dyspnea, FEV1, FVC, Intra-cavitary drainage, bullous lung disease


Background: Giant bullae (GB) are space occupying lesions associated with chronic respiratory symptoms. The aim of this study is to evaluate outcome of intra-cavitary tube drainage procedures (ITDP) in terms of clinical and radiological benefits. Methods: A prospective study was conducted in The Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, from February 2021 to April 2022 after ethical approval. Patients above 12 years, with poor reserve and GB underwent clinical, radiological and laboratory assessment before and after ITDPs to document various studied parameters. Results: A total of 48 patients were included; thirty-two (66.7%) were males. Mean age was 46.7±12.14 years. Most common aetiology was COPD (28; 58.3%). GB were ≥10 cm in size in 36 (75%) with right upper lobe involvement in 20 (41.7%). Preoperative dyspnoea score of IV was seen in 41 (85.4%) and chest pain in 42(87.5%) patients. In 34(70.8%) patients, Monaldi procedure and in 14 (29.2%) Brompton technique was used. Dyspnoea score improved from grade IV to II (24/41; p=0.004) along with reduction in pain and cough (p=0.012; p=0.002), respectively. Improvement post operatively in oxygen saturation, forced vital capacity, forced expiratory volume in 1 sec (6.08±1.36%, 0.73±0.516 L and 0.57±0.07 L, respectively, p<0.001) was seen. Partial pressure of oxygen (PaO2) and carbon dioxide improved by 40.6±4.82 (p=0.009) and 13.22±3.62mmHg (p=0.7). Improvement of PaO2 was associated with reduction in the size of bullae (9.33±5.13cm; p=0.006). Radiographical resolution was seen in 41 (87.5%) majorly within 2 months (21; 51.2%). Duration of hospital stay was 4.20 ±0.92 days with no mortality. Complications were seen in 25 (52.1%) patients. Conclusion: intra-cavitary tube drainage procedures allow both clinical and physiological improvement in patients with GB. They allow resolution of bullae in patients with poor reserves and help in expansion of underlying compressed lung, improving both the clinical symptoms and radiological picture.

Author Biography


Department of Thoracic Surgery , WARD 27 , Jinnah Postgraduate Medical Centre, Karachi


Santini M, Fiorelli A, Vicidomini G, Di Crescenzo V, Messina G, Laperuta P. Endobronchial treatment of giant emphysematous bullae with one-way valves: a new approach for surgically unfit patients. Eur J Cardiothoracic Surg 2011;40(6):1425–31.

Zhu C, Chen Z, Chen B, Zhu H, Rice-Narusch W, Cai X, et al. Thoracoscopic Treatment of Giant Pulmonary Bullae. J Surg Res 2019;243:206–12.

Fatimi SH, Riaz M, Hanif HM, Muzaffar M. Asymptomatic presentation of giant bulla of the left apical and anterior segment of the left upper lobe of the lung with near complete atelectasis of the remaining left lung. J Pak Med Assoc 2012;62(2):165–6.

Van Bael K, La Meir M, Vanoverbeke H. Video-assisted Thoracoscopic Resection of a Giant Bulla in Vanishing Lung Syndrome: case report and a short literature review. J Cardiothorac Surg 2014;9(1).

Greenberg J, Singhal S, Kaiser L. Giant bullous lung disease: evaluation, selection, techniques, and outcomes. Chest Surg Clin N Am 2003;13(4):631–49.

Im Y, Farooqi S, Mora A. Vanishing Lung Syndrome. Proc (Bayl Univ Med Cent) 2016;29(4):399–401.

Gunnarsson S, Johannesson K, Gudjonsdottir M, Magnusson B, Jonsson S, Gudbjartsson T. Incidence and Outcomes of Surgical Resection for Giant Pulmonary Bullae — A Population-Based Study. Scand J Surg 2012;101(3):166–69.

Ferreira JE, Costa P, Silveira L, Almeida L, Salvioni N, Loureiro B. Giant bullous emphysema mistaken for traumatic pneumothorax. Int J Surg Case Rep 2019;56:50–54.

Buero A, Nardi W, Lyons G, Quadrelli S, Chimondeguy D. Entirely thoracoscopic resection of a giant emphysematous bulla. Pan Afr Med J 2018;30:247.

Berkel VV, Kuo E, Meyers B. Pneumothorax, Bullous Disease, and Emphysema. Surg Clin North Am 2010;90(5):935–53.

Shah SS, Goldstraw P. Surgical treatment of bullous emphysema: experience with the Brompton technique. Ann Thorac Surg 1994;58(5):1452–6.

Lone YA, Dar AM, Sharma ML, Robbani I, Sarmast AH, Mushtaq E, et al. Outcome of the surgical treatment of bullous lung disease: a prospective study. Tanaffos 2012;11(2):27–33.

Palla A, Desideri M, Rossi G, Bardi G, Mazzantini D, Mussi A, et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest 2005;128(4):2043–50.

Vigneswaran W, Townsend E, Fountain S. Surgery for bullous disease of the lung. Eur J Cardiothorac Surg 1992;6(8):427–30.

Schipper PH, Meyers BF, Battafarano RJ, Guthrie TJ, Patterson GA, Cooper JD. Outcomes after resection of giant emphysematous bullae. Ann Thorac Surg 2004;78(3):976–82.

Venn GE, Williams PR, Goldstraw P. Intracavity drainage for bullous, emphysematous lung disease: experience with the Brompton technique. Thorax 1988;43(12):998-1002.

Negussie T, Haile L, GebreSelassie H, Temesgen F, Tizazu A. Giant pulmonary bullae in children. J Pediatr Surg Case Rep 2020;60:101569.

Aramini B, Ruggiero C, Stefani A, Morandi U. Giant bulla or pneumothorax: How to distinguish. Int J Surg Case Rep 2019;62:21–3.

Giller D, Scherbakova G, Giller B, Khanin A, Nikolenko V, Sinelnikov M. Surgical treatment of bilateral vanishing lung syndrome: a case report. J Cardiothorac Surg 2020;15(1):201.

Macarthur AM, Fountain SW. Intracavity suction and drainage in the treatment of emphysematous bullae. Thorax 1977;32(6):668–72.