Vanishing Lung Syndrome as a cause other than heart attack
- Sudden collapse in young athletic persons -

Dr Sidartha Lukram *

There have been numerous reports of sudden deaths among young athletic individuals recently during exercise and exertion. One of the major causes most people and doctors tend to consider first is cardiac issues, particularly heart attacks.

Although heart attacks are a leading cause of sudden death, spontaneous pneumothorax and giant bullae are also known to cause sudden breathing difficulties and collapse, leading to hypoxemic brain damage and heart stoppage.

Here, we discuss our experience with spontaneous pneumothorax and giant bullae producing breathlessness that require emergency treatment. Giant bullous emphysema (GBE), also known as Vanishing Lung Syndrome, is a rare condition typically occurring in young, thin, heavy-smoking men, characterized by giant bullae in one or both upper lobes, occupying at least one-third of the hemithorax and compressing the surrounding lung parenchyma.

Idiopathic giant bullous emphysema is a rare syndrome that differs from conventional bullous emphysema, affecting a younger population, mostly young men, the majority of whom are smokers. It is a rare manifestation of chronic obstructive pulmonary disease (COPD) and is associated with high mortality.

Patients with tubercular lungs, asthma, and COPD are more prone to this condition. It can be diagnosed with a simple chest X-ray. The X-ray below shows the chest of a smoker we encountered who presented with breathing difficulty, revealing collapse or absence of lung tissue on the right side. He had developed breathing difficulty and collapsed while playing football. He was an occasional smoker.

During surgery, a bullae was found leaking air into the chest cavity. A typical presentation can be seen in long-term smokers, with breathlessness on exertion and progressive shortness of breath, sometimes associated with a productive cough. Giant bullous emphysema is commonly found in long-term smokers and patients with alpha-1 antitrypsin deficiency.

It is associated with a high mortality rate, affecting more than five percent of the global population, with a prevalence of 12% in adults over the age of 30. Therefore, early diagnosis and appropriate treatment are vital. However, it is challenging to differentiate giant bullous emphysema from pneumothorax based solely on clinical presentation and plain radiographs. The gold standard for diagnosis is chest CT scan.

In asymptomatic patients, a relatively conservative approach, including nebulized bronchodilators, is employed. However, in symptomatic patients, surgical interventions such as stapled bullectomies, endocavitary drainage, volume reduction with video-assisted thoracoscopic surgery, one-way endobronchial valves, or lung transplants may be considered.

Surgical bullectomy (either by thoracotomy or thoracoscopy) is indicated to relieve pulmonary compression and eliminate the risk of pneumothorax for selected patients, following an assessment of pulmonary function and exercise capacity. The operative mortality rate is reported to be low.

The bottom line is that, if treated in time, this condition is curable and life-saving. The key message is that young individuals experiencing breathing difficulties should undergo regular check-ups with a doctor. People with asthma, a history of tuberculosis, and smokers are particularly prone to this disease. If not treated promptly, it can cause syncopal attacks and death.

A simple examination with a stethoscope and a chest X-ray can diagnose most cases. With the prevalence of post-COVID symptoms, even healthy and athletic individuals should be cautious and consult a doctor if they experience any breathing difficulties.

While heart issues are the most common cause, lung problems should not be overlooked in young athletic individuals.