Presentation
Cough and dyspnea.
Patient Data
Severe bullous emphysema both lungs, left worse than right. No pneumothorax, edema or pneumonia.
Severe bullous emphysema both lungs, left worse than right. Areas of increased pulmonary opacity likely represent atelectasis due to mass effect from the bullae. No pneumothorax, edema or pneumonia. No pulmonary embolism.
Severe bullous emphysema both lungs, left worse than right with worsening on the left compared to 3 years prior. No pneumothorax, edema or pneumonia.
Pneumothoraces and bullae have different shapes as shown above: a bulla is shaped like a bubble and compresses adjacent normal lung.
Case Discussion
A pulmonary bulla may simulate a pneumothorax: mistaken chest tube placement can result in a bronchopleural fistula. Stability on old films is helpful to confirm a bulla. In addition, bullae tend to be bilateral and often have internal "cobwebs". Bullae and pneumothoraces have different shapes: a bulla is like a bubble in the upper lung, displacing normal lung inferiorly, please see the diagram above. Unfortunately, bullae occasionally rupture and cause a pneumothorax which results in a confusing appearance.