Vanishing Lung Syndrome, or Idiopathic Giant Bullous Emphysema, with Pneumothorax, and Subcutaneous Emphysema in a 58-Year- Old Female Smoker with Chronic Obstructive Pulmonary Disease

Patient: Female, 58-year-oldFinal Diagnosis: Giant bullae center dot spontaneous pneumothorax center dot subcutaneous emphysemaSymptoms: Crepitus center dot dysphagia center dot dysphonia center dot facial swelling Medication: -Clinical Procedure: -Specialty: Critical Care Medicine center dot PulmonologyObjective: Unusual clinical courseBackground: Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is a rare manifestation of chronic obstructive pulmonary disease (COPD) and usually occurs in middle-aged smokers. This report presents a 58-year-old female smoker with COPD and VLS who presented with spontaneous pneumothorax. The pneu-mothorax was managed with a chest tube and was later complicated by massive subcutaneous emphysema. Case Report: A 58-year-old woman with a past medical history of long-term smoking and COPD presented with worsen-ing shortness of breath. Upon initial evaluation, she had tachypnea and hypoxia (SpO2 93%). Chest radiogra-phy revealed a new right-sided pneumothorax on top of extensive bullous disease, which the patient already had. The drainage of the pneumothorax was successful with a pigtail catheter. However, during the following night, after insertion of the pigtail catheter, the patient developed massive subcutaneous emphysema, which was confirmed with imaging. The patient remained hemodynamically stable, and diffuse subcutaneous crepi-tus was present on examination. The pigtail catheter was repositioned, resulting in complete resolution of the subcutaneous emphysema in the following 2 weeks. Conclusions: This case highlights the importance of a timely diagnosis and management of the possible presentations and complications of VLS. Complications such as pneumothorax are life-threatening and require urgent manage-ment, taking precedence over the curative treatment for VLS, surgical bullectomy.