Herniation of emphysematous bulla through a chest tube site

A 69-year-old male cigarette smoker with bullous emphysema presented with progressive dyspnea, chest pain, and hemoptysis. Chest radiograph revealed 100% right-sided pneumothorax. A 28 F chest tube was inserted through the fifth intercostal space in the anterior axillary line. The chest tube was removed in 36 hours. The following day, the patient had an episode of coughing, which resulted in sudden protrusion of a 9-cm bulla through the chest tube site (Fig 1). The patient remained comfortable and afebrile. Computed tomography of the chest confirmed severe bullous disease, herniated bulla, and compression atelectasis in lower lung fields (Fig 2). The patient underwent emergency bullectomy through antero-lateral thoracotomy. Surgical findings revealed the eviscerated bulla to be a part of the right lower lobe. The patient was discharged home on the ninth postoperative day.Figure 2View Large Image Figure ViewerDownload (PPT)