Patient work-up for bullectomy

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Abstract
A locali7ed area of hypertransradiance ofien leads to surgical refcrral. Among 608 cases. 115 were due to local lesions of airways, blood vessels, or parenchyma. Among the rema~ning 493 w~th bullae from diffuse emphysema, 21% underwent surgery. Good restoration of funct~on occurred in patients with rapidly progressive dyspnea who did not have a bronchitic component, recurrent infections, or CO? retention. Physiologically, preoperative findings suggestive of tension pneumothorax, ~ncluding aevere restriction, marked air trapping, and little ventilationlperfusion mismatch suggested good results. Favorable radiographic findings included well-defined, large air spaces without stlgmata of diffuse emphysema, serial films showing rapid enlargement of bullae, and expiration films with good thoracic motion and obscuration of lung around bullae. Compressed but otherwise intact lung was best demonstrated by angiography and CT scans. Palliative bullectomy in severe diffuse emphysema sometimes had gratifying clin~cal results. Resection of small bullae never caused Improvement. Localized giant bullae most often were associated with paraseptal or periacinar emphysema, and the best surgical results were obtained in thls group

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