Most patients with spontaneous pneumothorax secondary to bullous emphysema are successfully managed by chest-tube drainage. Occasionally a very large air leak prevents full lung expansion. The authors report on a patient in whom thoracoscopic intracavitary drainage of a leaking bulla led to rapid resolution of the pneumothorax and obliteration of the bulla. A large bronchopleural fistula was converted to a controlled bronchocutaneous fistula. The authors conclude that when conventional management fails to provide full lung expansion in cases of pneumothorax secondary to bullous emphysema, thoracoscopic intracavitary drainage is useful.
Aged Aged, 80 and over