Special Article - Surgery Case Report
Austin J Surg. 2018; 5(3): 1133.
Intractable Hiccups Caused by Large Pulmonary Bullae Compressing the Phrenic Nerve
Chang YC*
Department of Thoracic Surgery, Tainan Municipal Hospital, Taiwan
*Corresponding author: Yi-Chien Chang: No.670, Chongde Road, East District, Tainan City 701, Taiwan
Received: February 12, 2018; Accepted: February 19, 2018; Published: February 26, 2018
Clinical Image
A 41-year-old woman had persistent and frequent hiccups for more than 1 year despite medical treatment. She denied any traumatic events. Serial studies including upper gastrointestinal pan endoscopy, laboratory examination, and electroencephalography showed negative findings. Computed tomography showed large pulmonary bullae adjacent to the pericardium (Figure 1). Surgical findings of video-assisted thoracoscopy revealed that the left phrenic nerve was compressed by large pulmonary bullae (Figure 2A, B). The bullae was excised using sharp dissection techniques, with the nerve preserved well (Figure 2C, D). The postoperative course was uneventful. The frequency of her hiccups gradually decreased in the months following the operation.
These images present a rare case of a large pulmonary bullae compressing the left phrenic nerve, resulting in frequent left diaphragm contraction with clinical presentation of intractable hiccups. The symptoms were resolved after surgical intervention.
Figure 1: Large pulmonary bullae adjacent to the pericardium.
Figure 2: The left phrenic nerve was compressed by large pulmonary bullae.
It was excised using sharp dissection techniques, with the nerve preserved
well.
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