Improvement of Progressive Vanishing Lung Syndrome in COPD: A 7-Year Radiological Evolution Case Report and Literature Review

Introduction: Vanishing lung syndrome (VLS) is a clinical condition that characterized by large bullae that compress the normal lung parenchyma. Longitudinal documentation of VLS disease progression and outcomes following endobronchial valve (EBV) treatment remains scarce, particularly for right middle lobe (RML) involvement. Case Presentation: We report a 7-year longterm follow-up case of a 73-year-old female with chronic obstructive pulmonary disease(COPD) who presented with progressive dyspnea and declining pulmonary function. Serial computed tomography scans over 7 years documented the gradual expansion of emphysematous changes predominantly in the RML, with corresponding deterioration in pulmonary function tests (FEV 1 decreased from 0.83L to 0.51L). Bronchoscopic lung volume reduction using a single endobronchial valve (EBV) was performed, leading to a significant improvement in dyspnea. Two months post-intervention, the patient demonstrated remarkable clinical improvement with a six-minute walking distance increase from 310 to 650 meters, FEV 1 recovery to 97% of baseline (0.81L), and radiological evidence of complete RML atelectasis with adjacent lobe re-expansion. Conclusion: This case underscores the insidious progression of VLS and highlights the utility of EBV therapy in the management of advanced cases. Keywords: vanishing lung syndrome, VLS, bronchoscopic lung volume reduction, BLVR, endobronchial valve, EBV, chronic obstructive pulmonary disease, COPD