Abstract Bronchoscopic lung volume reduction (BLVR) is a novel non-pharmacological intervention for patients with severe chronic obstructive pulmonary disease (COPD). The procedure involves placing one-way valves in the bronchi of a target lobe after confirming the absence of collateral ventilation, thereby reducing lung hyperinflation and improving respiratory mechanics. We report a case in which the functional effects of BLVR were successfully evaluated using dynamic digital radiography (DDR). The patient was a 72-year-old man with a history of bronchial asthma and COPD, who had been treated with an inhaled corticosteroid/long-acting beta-agonist combination at a local clinic. He was referred to our department after being found to have severely impaired pulmonary function during a preoperative evaluation for lipoma removal in the Department of Plastic Surgery. Because he complained of exertional dyspnea, a long-acting muscarinic antagonist was added to his regimen. Chest computed tomography revealed severe emphysematous changes in both lower lobes and the presence of a denture in the left B8 bronchus. Bronchoscopy was performed to remove the foreign body; however, extraction proved difficult, and surgical intervention was deemed intolerable due to his advanced COPD. To improve his pulmonary function and alleviate dyspnea, BLVR was performed in the right lower lobe. Postoperatively, the patient experienced marked improvement in exertional dyspnea as well as in forced expiratory volume in one second (FEV1), which increased from 0.79 L to 1.42 L. DDR imaging demonstrated not only improved expansion dynamics in the treated right lung but also enhancement of lung area change on the contralateral side during deep inspiration. Specifically, the lung area change ratio improved from 16.3% to 36.2% in the right lung and from 11.5% to 24.5% in the left lung. These findings suggest that BLVR can produce functional benefits extending beyond the treated lung, possibly by improving the mechanical efficiency of the thoracic cavity and ventilation distribution. DDR proved useful as a non-invasive, quantitative imaging tool for assessing dynamic lung motion and visualizing postoperative physiological improvement. This case highlights the potential of BLVR not only to relieve hyperinflation in the target lobe but also to enhance overall respiratory function, as objectively demonstrated by dynamic imaging. This abstract is funded by: None
Kobayashi et al. (Fri,) studied this question.