Case Report: A case of giant emphysematous bullae successfully treated with percutaneous aspiration and sclerotherapy for staged reduction of pulmonary bullae

Giant emphysematous bullae (GEB) in COPD patients typically require high-risk surgery, with limited and minimally invasive alternatives. This report describes a 70-year-old man with COPD GOLD 3 and bilateral GEB (dominant bulla 8.5 cm× 6.2 cm) who underwent a novel percutaneous serial sclerotherapy protocol: Under CT guidance, a puncture needle was inserted into the bulla cavity on 3 consecutive days, with daily instillation of polidocanol (total 30 mL) and attempted air aspiration (successfully retrieving 1,000 mL of gas on day 3). No pneumothorax, desaturation, or bleeding occurred peri-procedurally. A follow-up CT scan at 3 months demonstrated>70% bullae volume reduction with lung re-expansion, correlating with significant clinical improvement. This first-reported percutaneous aspiration and sclerotherapy for staged reduction of pulmonary bullae (PASS) approach offers a safe, effective, minimally invasive option for GEB management in surgically high-risk COPD patients, warranting further validation of the protocol.