Infected lung bulla

Case contributed by Dr Chris O'Donnell


>60 pack year history, with recent cough and green sputum, fever and feeling generally unwell. No relief with oral antibiotics.

Patient Data

Age: 55
Gender: Male

Large thin-walled air cavity in the right upper zone containing air/fluid levels (best seen on the lateral projection) with confluent lung opacity on the caudal margin of the cavity


CT for further assessment of chest radiographic findings

CT findings confirm the chest radiographic changes of a large air cavity in the right upper lobe with minor sparing of the anterior segment. Differential diagnosis is a loculated hydropneumothorax or air cyst (bulla) containing fluid. Note further large bullae in the left upper lobe. Cavitating malignancy is unlucky given the very thin cavity wall.

Case Discussion

GIven that the patient has large bullous emphysema in the left upper lobe, the findings in the right upper lobe are likely due to bullous emphysema. The air/fluid level is presumed to represent infected fluid as the patient had been unwell with septic symptoms for some time and is coughing up green sputum. Adjacent lung consolidation. The lack of response to antibiotics indicates that surgical drainage and even bulla excision will be required. 

"Smoking pack years" is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked.

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Case information

rID: 35033
Published: 25th Mar 2015
Last edited: 21st Nov 2015
System: Chest
Inclusion in quiz mode: Included

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