Very large bulla on background of COPD
Active smoker with 200 pack year history. Severe COPD on home O2. Presents with 2 weeks increased SOB, increased sputum production, cough.
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Portable AP study. Hyperinflated lungs with diffuse reticular changes.. Noted large (25cm) right lung bulla. Stable since 2010. No infiltrate noted. No pneumothorax. No effusion noted , though costodiaphragmatic angle not fully visualized. Aortic knob shows calcifications.
This patient was admitted to the ICU for management of COPD exacerbation. Treated with steroids, antibiotics, and nebulizer treatments. He was subsequently discharged after about a week. His stay was largely uncomplicated despite the impressive chest x-ray on admission.