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Logo of bmjThis ArticleThe BMJ
 
BMJ. 2007 July 28; 335(7612): 208.
PMCID: PMC1934483
A Memorable Patient

Knifeless lung surgery

Sadananda B Naik, physician and cardiologist, Alva's Health Centre, Moodabidri, India

The 70 year old patient had been admitted many times for exacerbations of his chronic obstructive pulmonary disease for the past several years, and he could barely walk despite the numerous bronchodilators and anticholinergic drugs he was taking. Recently, he was brought with severe breathlessness once again, but this time he did not respond and was referred to a tertiary care hospital for the management of respiratory failure.

He was put on a ventilator, and a few hours later he had a cardiac arrest. He was successfully resuscitated, but he then developed pneumothorax after the resuscitation. Fortunately, he responded well to ventilator therapy and intercostal drainage. A few days later he was discharged.

When he returned for follow-up, I noticed marked improvement in his dyspnoea. The beaming patient told me that he was cured of his disease. Examination and assessment of lung function confirmed his improvement. When I went through his discharge notes, I saw how his COPD had been “cured.”

The patient has had large emphysematous bullae in either lung, and these were ruptured during cardiac resuscitation. Luckily, the resulting pneumothorax was managed effectively. These emphysematous bullae compressed the adjacent normal lung tissue, so their obliteration allowed normal functioning of the lung tissue. This resulted in marked improvement in lung function and clinical symptoms.


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