Table 6

Factors associated with favourable or unfavourable outcome in classical bullectomy

ClinicalRapid progressive dyspnoea despite maximal medical therapyOlder age
Ex-smokerCo-morbid illness
Cardiac disease
Pulmonary hypertension
>10% weight loss
Frequent respiratory infections
Chronic bronchitis
PhysiologicalNormal FVC or slightly reducedFEV1 <35% pred
FEV1 >40% predLow trapped gas volume
Little reversibilityDecreased DL,CO
High trapped lung volume
Normal or near normal DL,CO
Normal Pa,O2 and Pa,CO2
 CXRBulla >1/3 hemithoraxVanishing lung syndrome
Poorly defined bullae
 CTLarge and localised bulla with vascular crowding and normal pulmonary parenchyma around bullaMultiple ill-defined bullae in underlying lung
 AngiographyVascular crowding with preserved distal vascular branchingVague bullae; disrupted vasculature elsewhere
 Isotope scanWell-localised matching defect with normal uptake and washout for underlying lungAbsence of target zones, poor washout in remaining lung
  • CXR: chest radiography

  • CT: computed tomography

  • FVC: forced vital capacity

  • FEV1: forced expiratory volume in one second

  • DL,CO: carbon monoxide diffusing capacity of the lung

  • Pa,O2; arterial oxygen tension

  • Pa,CO2; arterial carbon dioxide tension

  • Table modified from 68