Anatomy of a diver’s lungs: a simultaneous occurrence of bilateral giant bullae and primary squamous-cell carcinoma of the chest wall

Introduction: Bilateral giant pulmonary bullae are rarely seen among patients with emphysema and are usually associated with chronic obstructive pulmonary disease. Additionally, they can occur due to occupational exposure, smoking, or cocaine use. Primary chest wall (CW) tumors arising from soft tissue account for less than 2% of all primary tumors. However, metastatic CW tumors are relatively common in patients with lung cancer. Case presentation: A male patient presented with bilateral giant bullae (GB) occupying almost two-thirds of the left hemithorax and one-half of the right hemithorax. A surgical repair consisting of two separate procedures, first on the right then on the left, was scheduled. Initially, a video-assisted thoracoscopic bullectomy was performed on the right side. Between the operations, the patient developed a painful CW mass, which immediately became the subject of preoperative imaging and biopsy to determine its origin. A second open operation was performed to remove the left-sided GB, along with the CW tumor. Post-operative studies revealed a rare primary squamous cell carcinoma (SCC) that had been excised with clear margins, and they showed no other possible metastatic origin for the tumor. Discussion: The synchronous appearance of two obscure lung abnormalities raises the question of their relationship. Surgery can achieve favorable results in treating GB. Regarding SCC of the CW, early wide resection remains the best treatment to deter recurrence. Conclusion: This report describes a patient with bilateral giant bullae and primary SCC of the CW and emphasizes the importance of a definitive diagnosis and timely intervention when faced with an unusual presentation. Graphical abstract available at: https://links.lww.com/IJSCR/A198