CRA96 GIANT RIGHT LUNG BULLAE WITH MASS EFFECT IN A PATIENT WITH PNEUMOCONIOSISAND COPD: A POST VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) RECOVERY CASE

Noor Eliana Rozani, Nor Syamimi Mohd Isa, Haly Rozie Ahmad, Leong Swee Wei, Fatimah Azmah Mohammad, Noorul Adfiza Muhammad, Mona Zaria Nasaruddin, Kan Chan Siang

Hospital Sultan Idris Shah, Serdang, Selangor, Malaysia.

Introduction
Pneumoconiosis with Progressive Massive Fibrosis (PMF) remains a major occupational lung disease, particularly among individuals with prolonged dust exposure. When combined with Chronic Obstructive Pulmonary Disease (COPD), it can lead to complex and debilitating lung pathology. We report a rare case of a giant lung bullae with mass effect in a patient with both conditions, successfully managed with surgical intervention.

Case report
A 66-year-old ex-stone quarry worker and ex-smoker presented with worsening dyspnea. He had known pneumoconiosis with PMF and COPD.CT Thorax revealed a giant right lung bulla measuring 11.9 x 8.9 x 15 cm, compressing adjacent lung tissue and obliterating the right bronchus. Pulmonary function tests showed FEV1 at 38% and DLCO at 47%. A multidisciplinary team determined he was suitable for surgery.

He underwent Right Video-Assisted Thoracoscopic Surgery (VATS) and bullectomy. Intraoperatively, a bullae occupying approximately 50% of the thoracic cavity was excised. Post-operative recovery was complicated by persistent air leak and subcutaneous emphysema, both managed conservatively and he recovered well.

Discussion
This case illustrates the rare co-occurrence of pneumoconiosis-related PMF, COPD, and giant bullae with compressive effects. VATS bullectomy, while technically challenging, resulted in significant symptomatic and functional improvement.A timely surgical referral can offer meaningful benefits even in advanced disease stages.