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Lung diseases

Pregnant With lung Bulla

09/02/2010

Question:

Dear Doctor,

I had an x-ray and it was dicovered that I have a large bulla in my lung. Well now I`m pregnant and due in 2 months. The MD`s tell me that my bulla can rupture during the delivery. What are the chances of it rupturing? Do I absolutely need a c-section? What will happen if the bulla rusptures during delivery? Would that cause me to have immediate surgery to repair the lung?

Answer:

As many questions, this is actually 4 questions, not just one. I will try to answer in order after some initial comments. As always, I do not have access to full information so I will attempt to discuss general points only related to bullae and their potential rupture and treatment.

" A large bullae" implies a thin-walled cystic structure which may have a number of causes including congenital (from birth).  The consideration of the full spectrum of causes is also important to exclude any lung problem that requires additional attention or diagnosis. It is possible to have an isolated bullae without underlying problems in the rest of the lung. The dimensions of this structure are not included and may be broadly relevant in answering questions below. A giant bullae is defined as occupying 1/3 of the chest cavity on the affected side and may indicate a future need for surgery regardless of rupture or stability, depending on a number of factors. Pulmonary function testing is also not included, which may also be relevant in assessing the current situation.

1) What are the chances of it rupturing?
There are no extensive studies that exist to conclusively answer this. In general, rupture is infrequent but certainly has been reported. I am not aware of any relationship between size and risk of rupture. There may be some increased risk of rupture in some underlying lung disorders which likely is not relevant in this case.

2. Do I absolutely need a c-section?
Risks, benefits and alternatives should be discussed with your obstetrician. There may be options that minimize "pushing" and increasing pressure within the chest on this "bullae" during a vaginal delivery. Your physicians willl assist you in understanding whether these may be appropriate in your case.

3. What will happen if the bulla ruptures during delivery?
Rupture of bullae would resonably be expected to be accompanied by release of air from the bullae into the space between the lung and chest wal,l causing something called a pneumothorax. Defined, a pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. Clinically this often results in shortness of breath and chest pain. If the collection is significant, it would need to be drained at that time. (See below). Rare but possible more serious complications of a pneumothorax include "tension" pneumothorax and very rarely - air embolism. Discussion of these is beyond the scope of the question.

4. Would that cause me to have immediate surgery to repair the lung?
Pneumothorax, if large enough, would require initial drainage (as noted in #3 above) usually by some type of chest tube. This is a plastic tube inserted through the chest wall into the space between the lung and chest wall and connected to a vaccuum or sealed container. This drainage tube and apparatus will allow the leaked air to escape and any collapse of the lung to re-expand. If there is no ongoing leak or other issues, the tube is removed, and no further treatment is needed. If there is ongoing leak after the tube is placed or other extenuating circumstances, then some procedure to stop the leak is often undertaken at some point typically determined by the amount and consequence of the leak.

These surgeries to stop the leak range from trying to scar the lining of the lung (pleurodesis) with or without resection (cutting out) the leaking part. Rarely, attempts to seal the leak from the inside of the lung have been attempted with mixed and often limited success.

As always, please direct these questions to the specialists caring for you so that they may discuss specific factors, options, risks and benefits of future plans with you.

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Response by:

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University