Current Thoracic Surgery

Smoking constitutes one of the most significant risk factors in the etiology of giant bullous emphysematous lung disease, leading to the development of massive bullous lesions. This clinical entity is one that poses a diagnostic challenge due to confusion with spontaneous pneumothorax on imaging modalities. In this case report, we present a 52-year-old male patient with underlying Chronic Obstructive Pulmonary Disease (COPD) and a significant history of smoking. The patient presented to the emergency department with chest pain and acute dyspnea. Following the detection of a giant bulla on thoracic computed tomography (CT), the patient was referred to our clinic due to respiratory limitation and the necessity for planned preventive surgical management. This presentation is primarily designed to address the identification of large lung bullae, their integrated management in conjunction with underlying COPD, the radiological criteria for differentiating a bulla from pneumothorax, and to share our operative observations regarding the surgical intervention.