case_images: PMC9356607_01
case_images: PMC9356607_02
case_images: Chest CT evolution (patient 1). (A): Baseline chest CT before endobronchial valves insertion in the left upper lobe (LUL). The circle shows a low attenuation zone next to the fissure. (B): Chest CT performed 35 days after valves insertion. We can see the complete atelectasis of the LUL (A), presence of pneumothorax (P) with subcutaneous emphysema, chest tube drainage and occurrence of a new bulla (B) next to the fissure. (C): Chest CT performed 83 days after valves insertion. The air leak resolved and the bulla (B) size is decreasing. (D): Chest CT performed 508 days after valves insertion with a complete resolution of the bulla.
case_images: COPD-17-1735-g0001.jpg
case_images: PMC9356607_02_COPD-17-1735-g0001.jpg
case_images: f0001
case_images: PMC9356607_03
case_images: Chest CT evolution (patient 4). (A) Baseline chest CT characterized by homogeneous emphysema. (B) Chest CT performed 7 days after valves insertion in the left upper lobe (LUL). We can see a complete atelectasis (A) of the LUL, a pneumothorax (P) of the left lung, pneumomediastinum, subcutaneous emphysema, chest tube drainage and a bulla (B) with air-liquid level. (C) Chest CT performed 26 days after valves insertion showing resolution of the air leak, bulla (B) with air-liquid level, the atelectasis (A) of the LUL and left lower lobe (LLL) infiltrates. (D) Chest CT performed 100 days after valves insertion characterized by resolution of the air leak and decreased size of the bulla (B) (always with air-liquid level) as well as the LLL infiltrates.
case_images: COPD-17-1735-g0004.jpg
case_images: PMC9356607_03_COPD-17-1735-g0004.jpg
case_images: f0004
case_images: An air-liquid level in the LUL bullae occurred within 2 days after EBV placement in patients 4, 5 and 6 (Figures 4, 5 and 6) and was associated with a bacterial infection documented by sputum culture, lung infiltrates on chest CT and high CRP level on blood analysis.
case_images: Chest CT evolution (patient 5). (A) Baseline chest CT before endobronchial valves insertion in the left upper lobe (LUL). (B) Chest CT performed one day after valves insertion. We can see the hypoventilation of the LUL, presence of a pneumothorax (P) which did not require chest tube drainage, pneumomediastinum and the occurrence of two new bullae (B) between the upper and lower lobes. (C) Chest CT performed 5 days after valves insertion. There is a regression of the pneumomediastinum, increasing of the atelectasis (A) and the bullae (B) with an air-liquid level. (D) Chest CT performed 63 days after valves insertion with a partial atelectasis of the LUL and a nearly complete resolution of both bullae (B).
case_images: COPD-17-1735-g0005.jpg
case_images: PMC9356607_03_COPD-17-1735-g0005.jpg
case_images: f0005
case_images: An air-liquid level in the LUL bullae occurred within 2 days after EBV placement in patients 4, 5 and 6 (Figures 4, 5 and 6) and was associated with a bacterial infection documented by sputum culture, lung infiltrates on chest CT and high CRP level on blood analysis.
case_images: Chest CT evolution (patient 6). (A) Baseline chest CT which is characterized by homogeneous emphysema. (B) Chest CT performed 12 days after valves insertion in the left upper lobe (LUL). We can see occurrence of partial atelectasis (A), pneumothorax (P), chest tube drainage and the presence of a bulla (B) in left fissure with air-liquid level. (C) Chest CT performed 82 days after valves insertion (7 days after valves removal for post-obstructive pneumonia) which is characterized by the loss of the LUL atelectasis and a persistent bulla (B) completely filled with liquid in the left fissure. (D) Chest CT performed 262 days after valves insertion (6 months after valves removal for post-obstructive pneumonia) showing a nearly complete resolution of the bulla (B).
case_images: COPD-17-1735-g0006.jpg
case_images: PMC9356607_03_COPD-17-1735-g0006.jpg
case_images: f0006
case_images: An air-liquid level in the LUL bullae occurred within 2 days after EBV placement in patients 4, 5 and 6 (Figures 4, 5 and 6) and was associated with a bacterial infection documented by sputum culture, lung infiltrates on chest CT and high CRP level on blood analysis. A bulla completely filled with liquid persisted in the left fissure but nearly completely resolved 6 months after valves removal (Figure 6D).