Thoracoscopic intracavitary drainage for pneumothorax secondary to bullous emphysema

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.