Giant bullous emphysema mistaken for traumatic pneumothorax

Introduction: Giant bullous emphysema (GBE) is defined by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding parenchyma [1]. Symptoms include dyspnea, hypoxia, chest pain and pressure, and hemoptysis [2], which can be complicated by pneumothorax and infection of the bullae [3]. Case presentation: A 50-year-old male was brought to the emergency department after he fell 5 m in a suicide attempt. The patient was in respiratory distress and had bilateral absence of breath sounds. He was intubated and bilateral chest tubes were inserted. A computerized tomography (CT) scan showed bilateral giant bullous emphysema in the upper lobes, confirming a diagnosis of GBE. As a result of the insertion of chest tubes, he developed bilateral high flow fistulas. During his hospitalization, he developed sepsis secondary to ventilator-associated pneumonia. In an attempt to control the fistulas, a right bullectomy was performed. Despite antibiotic treatment and surgical intervention, the patient died due to septic shock. Discussion: The clinical picture of a patient with GBE can be similar to that of pneumothorax, and GBE has been reported as being misdiagnosed as pneumothorax [4,5]. A CT scan can play an important role in differentiating these conditions [6], thus avoiding needle decompression, which can be catastrophic [6]. Conclusion: Giant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.