[Classification for bullous emphysema based on analysis of chest wall motion and pulmonary function before and after...

This study proposed a new classification for giant bullae based on analysis of chest wall motion during breathing efforts in the supine position using serial chest X-rays and examined the pulmonary function before and after bullectomy. Twenty-three patients with giant bullae were divided into two groups. Eight patients (group A) had a phase shift between the diaphragm motion and the rib cage motion or abnormal diaphragmatic motion. Almost all of them had dyspnea on exertion, and their FEV1.0 and MVV% had dyspnea on exertion, and their FEV1.0 and MVV%pred. were impaired but improved soon after bullectomy. Fifteen patients (group B) had good coordination of the diaphragm motion and rib cage motion. Most of them had no dyspnea and had normal pulmonary function. In addition, patients of group B were divided into three subgroups based on a phase shift between the diaphragm motion and inflation-deflation of giant bullae during a run. First, three patients whose bullae synchronized with the diaphragm motion showed significant decrease of %VC after bullectomy, and took a year for the decreased FEV1.0 and MVV%pred. to recover following the operation. Secondly, three patients whose bullae lay on the diaphragm and reached maximum size in the early phase of expiration showed little change in pulmonary function after bullectomy. Third, three patients whose bullae reached a maximum size at the end of expiration showed improvement of %VC and FEV1.0 soon after bullectomy. Chest wall distortion, defined as one side of caudal chest and upper abdomen not moving symmetrically compared with the other side, was found in three patients whose bullae were located in the middle and lower lung fields.(ABSTRACT TRUNCATED AT 250 WORDS)