Clinical Images  |   August 2017
Vanishing Lung Syndrome
Author Notes
  • From the Hurley Medical Center (Dr Al Hadidi) in Flint, Michigan, and Michigan State University (Dr Al Hadidi and Dr Shastri) in East Lansing. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Samer Al Hadidi, MD, MS, 2 Hurley Plaza, Suite 212, Flint, MI 48503-5905. E-mail:
Article Information
Imaging / Pulmonary Disorders / Clinical Images
Clinical Images   |   August 2017
Vanishing Lung Syndrome
The Journal of the American Osteopathic Association, August 2017, Vol. 117, 541. doi:
The Journal of the American Osteopathic Association, August 2017, Vol. 117, 541. doi:
A 39-year-old man presented with a 1-year history of dyspnea on exertion and a single episode of hemoptysis. Medical history was also significant for 15-pack-per-year cigarette use and mild intermittent asthma. Physical examination revealed diffuse bilateral wheezing and decreased air entry with hyperresonant percussion at the right lower lung. Laboratory results were normal. Chest radiograph (image A, arrow) demonstrated a giant right pulmonary bulla, supporting the diagnosis of vanishing lung syndrome. Partial right lung lobectomy was performed 8 months later, and a chest radiograph showed resolution of the bulla (image B, arrow). 
Vanishing lung syndrome is a chronic progressive condition. It is defined as bullae occupying at least one-third of the hemithorax.1 Risk factors include tobacco use, male sex, α-1-antitrypsin deficiency, and marijuana use.2-3 Tension pneumothorax is a potentially life-threatening complication. Although bullectomy is the treatment of choice, indications for surgical intervention should be individually assessed.4 
Sharma N, Justaniah AM, Kanne JP, Gurney JW, Mohammed TL. Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 2009;24(3):227-230. doi: 10.1097/RTI.0b013e31819b9f2a [CrossRef] [PubMed]
Hii SW, Tam JD, Thompson BR, Naughton MT. Bullous lung disease due to marijuana. Respirology. 2008;13(1):122-127. doi: 10.1111/j.1440-1843.2007.01186.x [CrossRef] [PubMed]
Hutchison DC, Cooper D; British Thoracic Society. Alpha-1-antitrypsin deficiency: smoking, decline in lung function and implications for therapeutic trials. Respir Med. 2002;96(11):872-880. [CrossRef] [PubMed]
Palla A, Desideri M, Rossi G, et al Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest. 2005;128(4):2043-2050. doi: 10.1378/chest.128.4.2043 [CrossRef] [PubMed]