Physical Medicine and Rehabilitation Management of Patient With Bilateral Lung Bullar: a Case Report

Tresia Fransiska Uliana Tambunan¹, Dinna Yulistya Ningrum², Dave Nicander Kurnain³

¹Cardiorespiration Division, Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta

²Physical Medicine and Rehabilitation Resident University of Indonesia, Jakarta

³Faculty of Medicine, Tarumanagara University, Jakarta

Correspondent:

Tresia Fransiska UT, Cardiorespiratory division, Physical Medicine and Rehabilitation department, University of Indonesia, Jakarta.

Email: fransiska_ut@yahoo.com.au   

Phone: +62 816-1976-762

Abstract

Lung bullae are defined as air spaces in the lungs, measuring more than 1 cm in diameter when distended, while giant bullae occupy at least 30% of the hemithorax. Bullae are thought to be in contact with the bronchial tree; they are preferentially filled during inspiration, causing collapse of the adjacent normal lung parenchyma. Clinical manifestations of giant bullae include cough, dyspnea, and chest pain, but in some cases, the condition may be asymptomatic. Although the diagnosis of infected bullae has been reported, tuberculosis as a causative pathogen is rare. This case Present a 27 year old male patient came to the medical rehabilitation department of feeling easily tired when walked more than 8 meters. The patient was initially diagnosed with pulmonary tuberculosis 14 months ago, and completed 12 months of antituberculosis treatment. He underwent a thoracotomy decortication wedge resection of the right superior lobe of lung and another thoracotomy to evacuate the haematoma and control the bleeding two weeks before admision. From the physical examination, he had forward head posture, rounded shoulders, and slight hyperkyphotic posture. Respiromotor status showed decreased chest expansion and asymmetrical movement during respiration. Two weeks after rehabilitation program consist of breathing control, chest expansion exercise, airway clearance technique, and aerobic exercises, the patient shows improvement.

Key words: Lung Bullae, Rehabilitation, Thoracotomy, Tuberculosis.

Abstrak

Bula paru didefinisikan sebagai ruang udara di paru-paru, berukuran diameter lebih dari 1 cm saat menggembung, sedangkan bula besar menempati setidaknya 30% hemithorax. Bula diperkirakan bersentuhan dengan cabang bronkial; yang terisi selama selama inspirasi, menyebabkan kolapsnya parenkim paru normal. Manifestasi klinis dari bula besar meliputi batuk, dispnea, dan nyeri dada, namun pada beberapa kasus, kondisi ini mungkin tidak menunjukkan gejala. Meskipun diagnosis bula yang terinfeksi telah dilaporkan, tuberkulosis sebagai patogen penyebab jarang terjadi. Laporan kasus ini melaporkan seorang laki-laki berusia 27 tahun datang ke bagian rehabilitasi medis dengan perasaan mudah lelah jika berjalan lebih dari 8 meter. Pasien awalnya terdiagnosis tuberkulosis paru 14 bulan yang lalu, dan menyelesaikan pengobatan antituberkulosis selama 12 bulan. Dia menjalani reseksi dekortikasi torakotomi pada lobus paru superior kanan dan torakotomi lainnya untuk mengevakuasi hematoma dan mengontrol pendarahan dua minggu sebelum datang ke rumah sakit. Dari pemeriksaan fisik didapatkan postur kepala ke depan, bahu membulat, dan postur sedikit hiperkimfosis. Status respiromotor menunjukkan penurunan ekspansi dada dan gerakan asimetris saat respirasi. Dua minggu setelah program rehabilitasi yang terdiri dari kontrol pernapasan, latihan ekspansi dada, teknik pembersihan jalan napas, dan latihan aerobik, pasien menunjukkan perbaikan.

Kata kunci: Bula paru, Rehabilitasi, Torakotomi, Tuberkulosis.