{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:12:35Z","timestamp":1778278355681,"version":"3.51.4"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,12,7]],"date-time":"2024-12-07T00:00:00Z","timestamp":1733529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>An emphysema bulla is defined as a distension greater than 1 cm of an airspace beyond the terminal bronchioles. Infection of an emphysema bulla is a common and serious complication of chronic obstructive pulmonary disease (COPD), which can lead to significant morbidity. Surgical intervention may be necessary in severe cases to prevent further complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>We present a case series of seven male patients with an average age of 46 years, all diagnosed with infected emphysema bullae. The predominant clinical symptom was chest pain, often accompanied by fever and chills. Chest X-rays revealed hyperclarity occupying more than two-thirds of the pulmonary field in all patients. A follow-up CT scan confirmed the presence of large bullous emphysema. All patients received antibiotics for one to two weeks before surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Surgical management was performed in all cases due to the severity of the infection and the size of the bullae. Postoperative recovery was uneventful in four patients. Two patients experienced prolonged air leaks requiring extended chest drainage, and one patient developed atelectasis, which resolved favorably with conservative management. This case series highlights the role of timely surgical intervention in the treatment of infected emphysema bullae and the associated postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Infected emphysema bullae represent a significant complication in patients with COPD. Surgical intervention, alongside antibiotic therapy, offers a safe and effective treatment option, resulting in favorable outcomes for most patients. Prompt diagnosis and management are crucial to avoiding severe complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110718","type":"journal-article","created":{"date-parts":[[2024,12,8]],"date-time":"2024-12-08T12:10:21Z","timestamp":1733659821000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Surgical management of infected emphysema bulla: A case series"],"prefix":"10.1097","volume":"126","author":[{"given":"Safa","family":"Boudabous","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Abderrahmane Mami Hospital-Ariana, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imen","family":"Bouacida","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Abderrahmane Mami Hospital-Ariana, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mouna Ben Hadj","family":"Yahia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Abderrahmane Mami Hospital-Ariana, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazem","family":"Zribi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Abderrahmane Mami Hospital-Ariana, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adel","family":"Marghli","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Abderrahmane Mami Hospital-Ariana, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"12","key":"R1-76-20260508","doi-asserted-by":"crossref","first-page":"3760","DOI":"10.1097\/JS9.0000000000000940","article-title":"Preferred reporting of case series in surgery (PROCESS) 2023 guidelines.","volume":"109","author":"Mathew","year":"2023","journal-title":"Int. J. Surg."},{"key":"R3-76-20260508","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ijscr.2019.08.003","article-title":"Giant bulla or pneumothorax: how to distinguish","volume":"62","author":"Aramini","year":"2019","journal-title":"Int. J. Surg. Case Rep."},{"issue":"2","key":"R4-76-20260508","doi-asserted-by":"crossref","first-page":"179","DOI":"10.4103\/0970-2113.129874","article-title":"Air-fluid level in the right lung","volume":"31","author":"Bhardwaj","year":"2014","journal-title":"Lung India : Official Organ of Indian Chest Society. juin"},{"issue":"2","key":"R5-76-20260508","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1183\/09031936.00158807","article-title":"Fluid-containing emphysematous bullae: a spectrum of illness","volume":"32","author":"Chandra","year":"2008","journal-title":"Eur Respir J. ao\u00fbt"},{"issue":"4","key":"R6-76-20260508","doi-asserted-by":"crossref","first-page":"642","DOI":"10.4187\/respcare.01372","article-title":"Lung bullae with air-fluid levels: what is the appropriate therapeutic approach?","volume":"57","author":"Henao-Martinez","year":"2012","journal-title":"Respir Care. avr"},{"key":"R7-76-20260508","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40792-016-0151-8","article-title":"The development of large-cell carcinoma in the wall of a giant bulla complicated by hemorrhage","volume":"2","author":"Nakamura","year":"2016","journal-title":"Surg. Case Rep"},{"issue":"6","key":"R8-76-20260508","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1378\/chest.130.6.1942","article-title":"A 57-year-old man with a fluid-containing lung cavity: infection of an emphysematous bulla with methicillin-resistant Staphylococcus aureus","volume":"130","author":"Chandra","year":"2006","journal-title":"Chest. d\u00e9c"},{"issue":"1","key":"R12-76-20260508","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4103\/0971-3026.59749","article-title":"Image-guided percutaneous drainage of an emphysematous bulla with a fluid level","volume":"20","author":"Kalra","year":"2010","journal-title":"Indian J Radiol Imaging. f\u00e9vr"},{"issue":"6","key":"R13-76-20260508","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1510\/icvts.2006.131722","article-title":"Endoscopic drainage of an infected giant bulla","volume":"5","author":"Takanami","year":"2006","journal-title":"Interact. Cardiovasc. Thorac. Surg. d\u00e9c"},{"issue":"4","key":"R15-76-20260508","doi-asserted-by":"crossref","first-page":"642","DOI":"10.4187\/respcare.01372","article-title":"Lung bullae with air-fluid levels: what is the appropriate therapeutic approach?","volume":"57","author":"Henao-Martinez","year":"2012","journal-title":"Respir Care. avr"},{"key":"R16-76-20260508","first-page":"215","article-title":"Video-assisted thoracoscopic surgery in the treatment of patients with bullous emphysema","volume":"3","author":"Lin","year":"2010","journal-title":"Int. J. Gen. 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