Lungen- und Atemwegsmedizin

Background: Bullous disorder of the lung is primarily a medical problem. A bulla is an air-filled space of 1 cm in diameter within the lung which has developed because of emphysematous destruction of the lung parenchyma. Eighty percent of patients presenting with bullae have associated pulmonary emphysema, and this entity, therefore, is referred to as bullous emphysema. A bulla that takes up a third or more of the space in and around the affected lung is called a giant bulla. Because of its close association with emphysema, giant bullae are most often found in older patients who smoke or used to smoke. The primary management of Giant bullous emphysema is often surgical. In this case, management involves the use of a minimally invasive surgery or Video Assisted Thoracoscopic Surgery (VATS). However, with decreased clinical study outcome, management results to technical difficulties.

Objective: To present and provide information on the diagnosis, management and clinical outcome of a case with bilateral Giant bullous lung disease in a 68 year old male diagnosed with emphysema.

Case synopsis: A case of an asymptomatic, physically active male diagnosed with emphysema. Initially found to have right pneumothorax. He underwent Chest tube thoracotomy on his right chest. On CT scan, he was noted to have bilateral giant bullous emphysema. He underwent Video assisted thoracoscopic surgery, right bullectomy with upper lobe segementectomy. During surgery, giant bullae of the left lung were left untouched. Post-operative course was uneventful. He was discharged in a stable condition.

Conclusion: Bullous emphysema may present with none to a severe distressing respiratory symptoms. In the event of sudden pleuritic chest pain with a history COPD, bullous emphysema should be a consideration. Avoidance of smoking prevents occurrence of COPD leading to bullous lung diseases.

Clinical recommendation: In conjunction with the decreased clinical study and absence of randomized control trial in the management and long outcome of treatment. Follow-up post discharge evaluation with accurate and adequate documentation is encouraged.

Background and objective: High flow nasal oxygen (HFNO) has been shown to reduce desaturations during flexible bronchoscopy. We evaluated outcomes of HFNO vs. low flow nasal oxygen (LFNO) on intraprocedural hypoxemia, the demand of sedative and reversal medications, postprocedure complications, procedure conversion to general anaesthesia and patient comfort during outpatient standard and EBUS (Endo Bronchial Ultrasound) guided bronchoscopy under conscious sedation.

Methods: A Prospective open-label study where the first 42 patients were allocated to LFNO and subsequent 42 patients were allocated to HFNO. Baseline and lowest oxygen saturation, duration of hypoxemia, procedure type, amount of sedative and reversal medications and patient comfort were assessed.

Results: Both HFNO and LFNO had similar characteristics at baseline. The odds ratio of being hypoxic (<90%) was 13.8 times more in the LFNO group (CI 3.55-70.7, p < 0.001) after adjustment for confounders. In addition, the LFNO group had a longer period of desaturation (OR 11.24, CI 3.18-49.78, p < 0.001). There was no statistically significant difference in median lowest peripheral oxygen saturation, the amount of sedative and reversal medications, patient comfort, procedure conversion to general anaesthesia, and post-procedure complications between the two groups.

Conclusion: During outpatient standard and EBUS guided bronchoscopy, HFNO is associated with a statistically significant reduction in oxygen desaturation and duration of hypoxemia. However, there was no clinically significant difference in adverse outcomes, or patient comfort between the two groups. We would like to highlight that LFNO can be considered safe to be used during outpatient bronchoscopy under conscious sedation which is cost effective. However, further multicentre studies are needed to identify high risk patients who will benefit most from HFNO.

There have been reported several complications after corona virus disease-2019 (COVID-19). Superinfections, especially secondary fungal diseases are now on rise in post-COVID-19 patients. Candida usually reflects airway colonization and true Candida pneumonia is rare but, can occur after hematologic dissemination from other body sites, such as the skin, gastrointestinal and genitourinary tract. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and increased susceptibility to fungal infections. We describe a case of invasive candidiasis in a 72-year-old post-COVID-19 diabetic male, who presented with cough, fever and cavitary lesion in lung seen on contrast-enhanced computed tomography (CECT) Chest. The patient’s sputum and blood cultures were positive for Candida