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The vanishing lung
  1. Palashkumar Jaiswal1,
  2. Jayakumar Sreenivasan1,
  3. Radhika Jaiswal2,
  4. Aman Kugasia3,4,
  5. Kathryn A Radigan5,
  6. Anupam Basu6
  1. 1 Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
  2. 2 Department of Internal Medicine, Forest Hills Hospital, Forest Hills, New York, USA
  3. 3 Department of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
  4. 4 Department of Rheumatology, John H. Stroger, Jr. Hospital of Cook County Hospital, Chicago, Illinois, USA
  5. 5 Department of Pulmonary and Critical Care, John H. Stroger, Jr. Hospital of Cook County Hospital, Chicago, Illinois, USA
  6. 6 Department of Radiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
  1. Correspondence to Dr Palashkumar Jaiswal, Department of Internal Medicine, John H Stroger Hospital of Cook County Hospital, Chicago, IL 60612, USA; jaiswal.palash007{at}gmail.com

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Case report

A 48-year-old woman with medical history significant for 20 pack-years of smoking presented with decreased exercise tolerance for the last year. On examination, her respiratory rate was 18 and oxygen saturation was 96% on room air with absent breath sounds within the left lung field. Alpha-1 antitrypsin levels were normal. Chest radiograph revealed giant emphysematous bulla with concern for concurrent pneumothorax (figure 1). CT scan of the chest revealed a massive bulla without a ‘double wall sign’ making superimposed pneumothorax unlikely (figure 2). Chest tube insertion was deferred and patient underwent bullectomy. Prior to surgery, her exercise tolerance …

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