@article{ref1,
title="Giant bullous emphysema mistaken for traumatic pneumothorax",
journal="International journal of surgery case reports",
year="2019",
author="Ferreira Junior, E.G. and Costa, P.A. and Silveira, L.M.F.G. and Almeida, L.E.M. and Salvioni, N.C.P. and Loureiro, B.M.",
volume="56",
number="",
pages="50-54",
abstract="INTRODUCTION: Giant bullous emphysema (GBE) is defined by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding parenchyma [1]. Symptoms include dyspnea, hypoxia, chest pain and pressure, and hemoptysis [2], which can be complicated by pneumothorax and infection of the bullae [3]. Case presentation: A 50-year-old male was brought to the emergency department after he fell 5 m in a suicide attempt. The patient was in respiratory distress and had bilateral absence of breath sounds. He was intubated and bilateral chest tubes were inserted. A computerized tomography (CT) scan showed bilateral giant bullous emphysema in the upper lobes, confirming a diagnosis of GBE. As a result of the insertion of chest tubes, he developed bilateral high flow fistulas. During his hospitalization, he developed sepsis secondary to ventilator-associated pneumonia. In an attempt to control the fistulas, a right bullectomy was performed. Despite antibiotic treatment and surgical intervention, the patient died due to septic shock. <br><br>DISCUSSION: The clinical picture of a patient with GBE can be similar to that of pneumothorax, and GBE has been reported as being misdiagnosed as pneumothorax [4,5]. A CT scan can play an important role in differentiating these conditions [6], thus avoiding needle decompression, which can be catastrophic [6]. <br><br>CONCLUSION: Giant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement. © 2019 The Authors<p /><p>Language: en</p>",
language="en",
issn="2210-2612",
doi="10.1016/j.ijscr.2019.02.005",
url="http://dx.doi.org/10.1016/j.ijscr.2019.02.005"
}