A bulla (plural: bullae) is an air-filled pocket of lung tissue that can longer be expelled during expiration. Air moves into the lungs, but cannot move out of the bullae. Bullae infrequently occur in people with healthy lungs, but they form all too often in patients with chronic obstructive pulmonary disease or COPD. The only way to release the trapped air is to remove the bulla itself in a procedure known as a bullectomy. A bullectomy procedure is not always used to treat bullae, but may be used in certain conditions.
Surprisingly, most bullae do not cause problems with breathing, even though they encroach on healthy (or healthier) lung tissue. When many bullae form in the lungs, or if a very large bulla occupies the space normally reserved for healthy lung tissue, they can cause one or more symptoms or medical problems that may indicate a need for bullectomy. If a bulla expands to such a degree that it compresses other portions of the lung or on the heart, it can prevent normal breathing or adversely affect blood pressure throughout the body. Bullectomy is strongly considered in cases where the cardiovascular system is compromised.
Short of cardiopulmonary symptoms, bullae often cause distresseing symptoms for the patient and bullectomy is done to help curb them. Bullae can cause a great deal of pain in some instances—pain that is not adequately relieved with bullectomy. If bullae form near the periphery of the lung, they can cause the lung to collapse, which is extremely painful and can severely interfere with normal breathing. In some cases bullae can cause hemoptysis (coughing up blood) or they can become infected repeatedly. These latter symptoms may lead to bullectomy if medical management is insufficient.
There are a number of ways to perform bullectomy but the major distinction is whether both the right and left sides of the lungs have disease. If there is only bullae on one side, then a laparoscopic bullectomy procedure is preferred, which may also be referred to as a video-assisted thoracoscopy. In this approach a small incision and entry is made into one side of the chest and the bulla or bullae are removed. If a bullectomy is to be performed on both sides of the chest, a median sternotomy is usually performed. A median sternotomy requires that the sternum is cut lengthwise and the ribs are opened, similar to open heart surgery. If a bullectomy can be successfully performed using a laparoscope (thoracoscope), the recovery process is far easier for the patient; however, the extent of the lung disease may not permit a laparoscopic approach.
One of the main prerequisites for bullectomy is that the patient has enough lung function or will have after the surgery. Anyone that is being considered for bullectomy will need to successfully perform several breathing tests to demonstrate reasonable lung capacity. Since most patients with bullae also have moderate to severe COPD, many patients with multiple bullae do not qualify for bullectomy. These breathing tests are important because the mortality after bullectomy ranges from 2 to 12 %. People with good lung function do much better than those with poor lung function—so much so that surgeons simply refuse to operate if lung function is below a certain level, because the risk is too great otherwise.
If you are being considered for a bullectomy, it is important to speak with a pulmonologist and a thoracic (or cardiothoracic) surgeon to learn about the procedure and other treatment options in your case.