C45-23 One Sided Mystery, Spontaneous Pneumothorax and Vanishing Lung in a Young Pilot

Abstract Introduction Giant bullous emphysema also known as vanishing lung syndrome is a rare condition associated most typically with men who smoke and have underlying emphysema. Among case reports and case series, the common unifying aspect is that patients have paraseptal emphysema and subpleural bulla. Additionally, nearly all patients have bilateral involvement of the emphysema or bulla. Here we present a peculiar case of a young man with no emphysematous changes on the left, and a large bulla on the right. After right lower lobe bullectomy, his remaining right lung lacked emphysema. Case This is the case of a 27 year old man with history of childhood asthma (quiescent) and short history of vaping (2 years) who presented after swimming with several hours of chest pain and shortness of breath. He was found to have a large right sided pneumothorax on chest X-ray, however CT chest then revealed massive bulla in what appeared to be the right lower lobe. This patient had hobbies which included both flying small aircrafts as well as scuba diving and had done both in the preceding 3 months. His only risk factor for such a condition was that he recently began vaping, and had a remote history of marijuana use in his late teens, however had been abstinent since acceptance to flight school the year prior. Autoimmune and other serologic work up was unrevealing. Initially, after multiple days with a chest tube in place and no expansion of existing lung surgery was planned. Based on imaging it was unclear if pneumonectomy, lobectomy, or bullectomy would be the safest and most successful choice. After multiple multidisciplinary discussions with cardiothoracic surgery team, he received a right bullectomy with successful re-expansion of the right upper, middle, and remaining lower lobe without any additional blebs identified, additionally they performed intraoperative scratch pad mechanical pleurodesis. Discussion The current landscape understanding of non-emphysematous, unilateral bullous disease is limited. It is unclear what exact serology to send, how often to monitor imaging, and what surgeries are best long term. The short and long term outcomes of patients who undergo bullectomy with or without emphysema is not well known. With increasing case series and reports of patients with these diseases who undergo definitive management, this may help providers who are counseling patients on the risks and benefits of these invasive surgeries and continue to highlight the need for comprehensive review of these pathologies. This abstract is funded by: None