Minimally invasive resection of a marijuana-associated giant bulla : a case report

Abstract

BACKGROUND: Smoking is known to be a causative factor for emphysema. Literature also supports the possibility that marijuana abuse increases the probability of giant apical bullae in young individuals. Surgical resection is the only cure for giant bullae, whilst also having a prophylactic role. Video-assisted Thoracoscopic Surgery (VATS) bullectomy is thenew gold standard replacing thoracotomy.

CASE PRESENTATION: We present a 31-year old marijuana smoker with a history of multiple pneumothoraces who was found to have a large emphysematous bulla in the left upper lobe accompanied by a smaller bulla in the superior lingular segment. Even though he was asymptomatic at the time, VATS bullectomy was carried out in view of his multiple previous pneumothoraces. The patient recovered well after surgery, and a follow-up chest x-ray 2 weeks post-operatively showed a fully inflated lung.

CONCLUSION: This is the first case of giant bulla being removed via minimally invasive VATS in Malta. Apart from continuing to show the effectiveness and suitability of VATS in the treatment of this condition, we highlight the important link between marijuana and giant emphysematous bullae.