Q J Med 2014; 107:681–682 doi:10.1093/qjmed/hcu002 Advance Access Publication 18 January 2014
Clinical picture Giant pulmonary bullae mimicking spontaneous pneumothorax compressive atelectasis (Figure 1b). The patient underwent bullectomy of right bullae. The patient was in stable condition after 6 months of follow-up. Bullae are defined as an air space in the lung measuring above 1 cm in diameter when distended. Giant bullae are those that occupy at least 30% of the hemithorax. The most common etiology of bullae is cigarette smoking.1 Bullae can be asymptomatic or chest distress. Bullectomy will be necessary when bullae lead to severe dyspnea or are infected.2 It can be a diagnostic challenge between pneumothorax and giant bullae. With pneumothorax, visceral pleural white line and convex surface of lung should be present on image findings.
Figure 1. (a) Chest radiography revealed large lucent areas over the entire right thorax. (b) Computed tomography of chest demonstrated multiple giant bullae occupying the entire right thorax with right lung compressive atelectasis.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
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A 65-year-old man presented with a 2-week history of dyspnea and chest distress. He reported smoking 2 packs per day for the last 40 years. He had no history of trauma or surgery. Physical examination revealed hyper resonance and decreased breath sounds on the right thorax. Laboratory investigations were unremarkable. Electrocardiogram showed normal sinus rhythm. Chest radiography revealed large lucent areas over the entire right thorax (Figure 1a). A chest tube was inserted under the diagnosis of spontaneous pneumothorax. Followup chest radiography showed no expansion of the right lung. Computed tomography of chest subsequently demonstrated multiple giant bullae occupying the entire right thorax with right lung
682
Clinical picture
With bullae, concave surface of lung can be demonstrated and chest tube insertion should be unnecessary.3 Giant bullae and pneumothorax should be differentiated in detail when chest radiography in a smoker presents with large lucent areas. Photographs and text from: C.-T. Chen, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.; S.-Y. Chang, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C. email: [email protected]
Conflict of interest: None declared.
References 1. Johnson MK, Smith RP, Morrison D, Laszlo G, White RJ. Large lung bullae in marijuana smokers. Thorax 2000; 55:340–2. 2. Palla A, Desideri M, Rossi G, Bardi G, Mazzantini D, Mussi A, et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest 2005; 128:2043–50. 3. Milne ME, McCowan C, Landon BP. Spontaneous feline pneumothorax caused by ruptured pulmonary bullae associated with possible bronchopulmonary dysplasia. J Am Anim Hosp Assoc 2010; 46:138–42.
Downloaded from by guest on November 15, 2015
Clinical picture Giant pulmonary bullae mimicking spontaneous pneumothorax compressive atelectasis (Figure 1b). The patient underwent bullectomy of right bullae. The patient was in stable condition after 6 months of follow-up. Bullae are defined as an air space in the lung measuring above 1 cm in diameter when distended. Giant bullae are those that occupy at least 30% of the hemithorax. The most common etiology of bullae is cigarette smoking.1 Bullae can be asymptomatic or chest distress. Bullectomy will be necessary when bullae lead to severe dyspnea or are infected.2 It can be a diagnostic challenge between pneumothorax and giant bullae. With pneumothorax, visceral pleural white line and convex surface of lung should be present on image findings.
Figure 1. (a) Chest radiography revealed large lucent areas over the entire right thorax. (b) Computed tomography of chest demonstrated multiple giant bullae occupying the entire right thorax with right lung compressive atelectasis.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 15, 2015
A 65-year-old man presented with a 2-week history of dyspnea and chest distress. He reported smoking 2 packs per day for the last 40 years. He had no history of trauma or surgery. Physical examination revealed hyper resonance and decreased breath sounds on the right thorax. Laboratory investigations were unremarkable. Electrocardiogram showed normal sinus rhythm. Chest radiography revealed large lucent areas over the entire right thorax (Figure 1a). A chest tube was inserted under the diagnosis of spontaneous pneumothorax. Followup chest radiography showed no expansion of the right lung. Computed tomography of chest subsequently demonstrated multiple giant bullae occupying the entire right thorax with right lung
682
Clinical picture
With bullae, concave surface of lung can be demonstrated and chest tube insertion should be unnecessary.3 Giant bullae and pneumothorax should be differentiated in detail when chest radiography in a smoker presents with large lucent areas. Photographs and text from: C.-T. Chen, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.; S.-Y. Chang, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C. email: [email protected]
Conflict of interest: None declared.
References 1. Johnson MK, Smith RP, Morrison D, Laszlo G, White RJ. Large lung bullae in marijuana smokers. Thorax 2000; 55:340–2. 2. Palla A, Desideri M, Rossi G, Bardi G, Mazzantini D, Mussi A, et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest 2005; 128:2043–50. 3. Milne ME, McCowan C, Landon BP. Spontaneous feline pneumothorax caused by ruptured pulmonary bullae associated with possible bronchopulmonary dysplasia. J Am Anim Hosp Assoc 2010; 46:138–42.
Downloaded from by guest on November 15, 2015
