Physical Medicine and Rehabilitation Role in Pre-Operative Management of Patient with Giant Bullae of Right Lung with Scoliosis and a History of Systemic Lupus Erythematosus: A Case Report

Abstract

Giant bullae refers to the enlargement of one or more bullae occupying more than one-third of the hemithorax. It creates larger and less efficient lung sacs that can’t properly manage the normal gas exchange during breathing. Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease with pulmonary manifestations is giant bullae due to excessive surface tension secondary to surfactant failure. Female patient with history of SLE presenting with shortness of breath during moderate-intensity activities. CT Scan showed giant emphysematous bullae in her right hemithorax. Patient had double curve scoliosis which may affect her chest expansion. Evaluation of respiratory functions showed lung restrictive disease and its predictive post-operative value of forced expiratory volume in one second (ppoFEV1) below 30%. During 8 weeks pulmonary rehabilitation program patient’s clinical state is improved and associated with increase in forced expiratory volume in one second (FEV1). Home based aerobic exercise consisted of walk 15 minutes/day, 5 days a week. Due to her limited chest expansion, active breathing exercise and scoliosis program exercise administered in the rehabilitation program. This case report elaborates on the effect of the pre-operative pulmonary rehabilitation program in improving respiratory function and its readiness to undergo surgical treatment.