When Bullae Deceive: A Rare Case of Vanishing Lung Syndrome Misdiagnosed as Pneumothorax

Abstract

Background: Vanishing lung syndrome (VLS), also referred to as giant bullous emphysema, is an uncommon form of lung disease in which massive bullae replace a substantial portion (typically more than one third) of the hemithorax, leading to compression of surrounding healthy lung tissue. It typically occurs in young male smokers but may also arise in non-smokers with biomass exposure, making diagnosis and management particularly challenging.
Case Presentation: We describe a case involving a 51-year-old non-smoking woman with long-term exposure to biomass fuel, who presented with dry cough, chest discomfort, and gradually worsening shortness of breath. An initial chest X-ray was interpreted as a left-sided pneumothorax, for which an intercostal chest drain was placed; however, clinical and radiological improvement was not achieved. Subsequent high-resolution computed tomography revealed a large emphysematous bulla occupying the left lower lobe and causing a contralateral mediastinal shift, findings consistent with vanishing lung syndrome. The patient underwent successful surgical management via left posterolateral thoracotomy and bullectomy, resulting in marked clinical improvement.
Conclusion: This case highlights the critical need to distinguish vanishing lung syndrome from pneumothorax, particularly in individuals with non-traditional risk factors like prolonged biomass smoke exposure. Early recognition and surgical intervention can lead to substantial symptomatic and functional recovery.