In addition, the infection usually bull [

We describe here a rare case of idiopathic bullous emphysema / Endangered lung syndrome (VLS) in 33-year-old patient with a history of abuse of marijuana, which is in the hospital with chest pain is due to pneumothorax based on chest radiograph. This case highlights the need for computer tomography of the chest in relatively stable patients with suspected VLS, to reduce the potential risk control bronhoplevralnyy fistula. A. Case Presentation

Our patient 33-year old man who was adopted with complaints of shortness of breath. The patient denied fever, trauma. He was initially hypoxic and required 3liters oxygen. Patients history was positive for smoking, 1pack a day lasix 12 mg for the past 15 years, the abuse of marijuana and off the last 10 years, he worked as a laborer. First, laboratory tests, including complete blood count with differential complete metabolic profile, cardiac enzymes, brain natriuretic peptide and ECG were within normal limits. Initial analysis of arterial blood gas on three liters of oxygen showed ph 7. 47, PO2 150 and pCO2 38. Chest X-ray showed a large bullous lesions made on both sides of concern right pneumothorax (Fig.

). Chest tube was placed, but the CXR remained unchanged. Chest X-ray showed a large bullous lesions mistaken as pneumothorax (Fig.

). CT of the chest showed a diagnosis of giant bullous emphysema (GBE) (Fig.

s). Urine toxicology was negative. Since alpha-1 antitrypsin negative study, it was concluded if the disappearance of light syndrome (VLS) / Idiopathic giant bullous emphysema with known traditional risk factors of tobacco and marijuana abuse. The patient was discharged after three days of indoor air with a plan of complete pulmonary function and out-patient pulmonary rehabilitation with the possibility of bullectomy. 2. Discussion

separate clinical syndrome, giant bullous emphysema or VLS, the main bullosa lung disease, or type I bullosa disease is defined as the great bull is at least one third of half a bunch of cells [

]. Risk factors include smoking, alpha-1 antitrypsin and marijuana abuse [

]. Smoking marijuana leads to asymmetric bullosa disease, often in a normal chest X-ray and lung. Patients who smoke marijuana, these pathological changes occur at a younger age (about 20years earlier) than in smokers of tobacco [

]. Radiographic criteria for the disappearance of light syndrome as defined by Roberts and colleagues [

] include presence of giant bullae in one or both upper lobes, occupying at least one third of half a bunch of cells and compression of surrounding normal parenchyma of the lungs [

]. The main complication is pneumothorax VLS, which classically includes a history of acute deterioration in respiratory function associated with chest pain. In addition, the infection usually bull [

]. High resolution computed tomography (KTVRZ) is used for preoperative evaluation and shows the extent and distribution bullosa diseases to pinpoint the possible cause of symptoms. KTVRZ also to evaluate the associated diseases, such as infected cysts, bronchiectasis, pulmonary artery enlargement and pneumothorax [

]. Identification of preoperative bull allows the prediction of expected increase in postoperative FEV1. Bullectomy causes significant improvement in dyspnea, gas exchange, pulmonary function and exercise tolerance, with the best results are obtained in more significant cases of VLS. On average, the improvement persists for approximately 3 to 4 years, but began to decline after [

]. Giant bullectomy shown to produce significant functional improvement immediately. This guide is reduced over time, but kept at least 3 years. This is based on the following from 43patients with giant bullous emphysema observed in the average length of 4. 5 years [

]. There was significant improvement in all three dimensions FVC, FEV and dyspnea classification in the early postoperative period, but 510 years only FVC improvement was significant [

]. 3. Conclusion

Endangered lung syndrome is a rare disease that is clinically manifested in a much more advanced stage. Patients should be strongly advised against any further tobacco and marijuana abuse. These patients should be referred to the pulmonary and cardio-surgery, to outline the next operation at the right time. .