Images in Pulmonary, Critical Care, Sleep Medicineand the Sciences

Emphysema!

Dirk-Jan Slebos1, Karin Klooster1, and Michiel Erasmus2

1Department of Pulmonary Diseases and 2Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen,

Groningen, The Netherlands

A 67-year-old man with end-stage emphysema characterized by severe dynamic hyperinflation was treated using an experimentalminor invasive surgical technique by creating a transthoracic airway bypass from the left upper lobe to his third intercostal space,resulting in a small “pneumostoma” (1). This newly created tract easily facilitates the release of his trapped air (2). Figures 1B and1C (as well as the video in the online supplement) show the endoscopic evaluation (using a bronchoscope) of his “transthoracicairway bypass,” where we were actually able to directly visualize the impressive destructive nature of his emphysema. These imagesare self-explanatory with respect to why these patients suffer from severe dyspnea. Figure 1A shows the anatomical location of theendoscopically visualized area.

Author disclosures are available with the text of this article at www.atsjournals.org.

References

1. Saad Junior R, Dorgan Neto V, Botter M, Stirbulov R, Rivaben JH, Goncalves R. Therapeutic application of collateral ventilation with pulmonary drainage

in the treatment of diffuse emphysema: report of the first three cases. J Bras Pneumol 2009;35:14–19.

2. Moore AJ, Cetti E, Haj-Yahia S, Carby M, Bjorling G, Karlsson S, Shah P, Goldstraw P, Moxham J, Jordan S, et al. Unilateral extrapulmonary airway

bypass in advanced emphysema. Ann Thorac Surg 2010;89:899–906.

Figure 1. (A) Thoracic computed tomog-

raphy scan showing severe bilateral em-

physema. The circle indicates the area

that was endoscopically visualized. (B andC) Transthoracic endoscopic view of the

left upper-lobe lung emphysematous

parenchyma.

Supported by Portaero Inc.

This article has a video supplement, which is accessible from this issue’s table of

contents at www.ats.journals.org

Am J Respir Crit Care Med Vol 186, Iss. 2, p 197, Jul 15, 2012

Copyright ª 2012 by the American Thoracic Society

DOI: 10.1164/rccm.201201-0067IM

Internet address: www.atsjournals.org