A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40×30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.
Cite this paper
Y. Hirami, K. Shimizu, R. Okita, S. Saisho, T. Yukawa, A. Maeda, K. Yasuda and M. Nakata, "Successful Two-Stage Surgical Treatment for Lung Cancer in a Patient with Contralateral Giant Emphysematous Bullae," Open Journal of Thoracic Surgery, Vol. 2 No. 4, 2012, pp. 133-135. doi: 10.4236/ojts.2012.24027.
 I. L. Stoloff, P. Karnofsky and L. Morgilnea, “The Risk of Lung Cancer in Males with Bullous Disease of the Lung,” Archives of Environmental Health, Vol. 22, No. 1, 1971, pp. 163-167.
 M. J. Goldstein, G. L. Snider, M. Liberson and R. M. Roske, “Bronchogenic Carcinoma and Giant Bullous Disease,” The American Review of Respiratory Disease, Vol. 97, No. 6, 1968, pp. 1062-1070.
 A. Palla, M. Desideri, G. Rossi, G. Bardi, D. Mazzanitini, A. Mussi and C. Giuntinic, “Elective Surgery for Giant Bullous Emphysema. A 5-Year Clinical and Functional Follow-Up,” Chest, Vol. 128, No. 4, 2005, pp. 2043-2050.
 M. X. FitzGerald, P. J. Keelan, D. W. Cugell and E. A. Gaensler, “Long-Term Results of Surgery for Bullous Emphysema,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 68, No. 4, 1974, pp. 566-587.
 G. F. Menconi, F. M. Antonietta Melfi, A. Mussi, A. Palla, M. C. Ambrogi and C. A. Angeletti, “Treatment by VATS of Giant Bullous Emphysema: Results,” European Journal of Cardio-Thoracic Surgery, Vol. 13, No. 1, 1998, pp. 66-70. doi:10.1016/S1010-7940(97)00294-7
 P. H. Schipper, B. F. Meyers, R. J. Battafarano, T. J. Guthrie, G. A. Patterson and J. D. Cooper, “Outcomes after Resection of Giant Emphysematous Bullae,” The Annals of Thoracic Surgery, Vol. 78, No. 3, 2004, pp. 976-982. doi:10.1016/j.athoracsur.2004.04.005
 P. Bhattacharyya, D. Sarkar, S. Nag, S. Ghosh and S. Roychoudhury, “Transbronchial Decompression of Emphysematous Bullae: A New Therapeutic Approach,” The European Respiratory Journal, Vol. 29, No. 5, 2007, pp. 1003-1006. doi:10.1183/09031936.00030106
 M. Santini, A. Fiorelli, G. Vicidomini, V. Giuseppe Di Crescenzo, G. Messina and P. Laperuta, “Endobronchial Treatment of Giant Emphysematous Bullae with One-Way Valves: A New Approach for Surgically Unfit Patients,” The European respiratory Journal, Vol. 40, No. 6, 2011, pp. 1425-1431.