Severe bullous emphysema. Successful surgical management despite poor preoperative blood gas levels and marked pulmonary hypertension.

Surgical removal of giant pulmonary bullae is usually considered inadvisable in patients with either hypoxemia or hypercapnia. A successful operation was performed on a patient with both hypoxemia and hypercapnia. Preoperative and postoperative physiologic data are presented. Those data which suggested a favorable outcome are compared with those which did not.