DOI: 10.5811/westjem.2013.3.16276

A 34-year-old black man presented to the emergency department with right-sided pleuritic chest pain, productive cough, low grade fever, and dyspnea. He had a history of emphysema, deep vein thrombosis, protein C and S deficiency, and inferior vena cava filter. His physical exam was significant for fever, tachypnea, tachycardia, and decreased breath sounds over the right upper and middle lung fields. We obtained a chest radiograph (Figure 1). DIAGNOSIS Giant emphysematous bulla is defined as air-filled spaces that occupy more than one-third of the hemithorax and develops in a lung destroyed by generalized emphysema.1 Treatment typically involves surgery, although a variety o