GIGANTIC Bullae
IMAGE 1: Sizeable bulla of the LLL in a 26-yo male non-smoker's case.

IMAGES 2-11: Gigantic and Numerous bullae of the left lung in a 27-yo male smoker's case (10 pack-yrs): intraoperative photographs and preoperative imaging (pulmonary perfusion scanning, CXR, CT).

IMAGES 12-15: Large bulla (max.dim. 7.8 cm) of the RLL in a 40-yo male smoker's (15 pack-yrs) case; the entire Inferior Pulmonary Vein's course was through the interior of the large bulla (the pulmonary tissue around the vein had been excessively degenerated). Suturing of the interior walls of the bulla to each other along with abrasion pleurodesis were initially attempted but, finally, a Lower Lobectomy had to be carried out.
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1. Sizeable bulla of the LLL (BLUE). GREEN arrows: the phrenic nerve's course on the pericardium

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2. Gigantic bulla ( ~8 cm) becomes apparent as soon as a limited thoracotomy (through the bed of the 6th rib) is carried out

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3. Numerous bullae of smaller size are found, post removal of the gigantic bulla

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4. Large bulla deeply inside the pulmonary tissue

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5. Large bulla, located deeper inside the thorax

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6. Preop radionuclide Scanning demonstrates excessively decreased Perfusion of the left lung

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7. Preoperative CXR of the very same case (images 2-11). BLUE: numerous large bullae

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8. Preoperative CT of the very same case (images 2-11). BLUE: numerous large bullae

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9. Preoperative CT of the very same case (images 2-11). BLUE: numerous large bullae

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10. Preoperative CT of the very same case (images 2-11). BLUE: numerous large bullae

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11. Preoperative CT of the very same case (images 2-11). Numerous large bullae

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12. The course of the Inferior Pulmonary Vein (BLUE arrows) is apparent through the interior of a Large bulla (GREEN), measuring 7.8 cm

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13. Preoperative CT. BLUE arrows: Inferior Pulmonary Vein. GREEN: the bulla

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14. Preoperative CT. BLUE arrows: Inferior Pulmonary Vein. GREEN: the bulla

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15. Preoperative CT. BLUE arrows: Inferior Pulmonary Vein. GREEN: the bulla