Clinical picture

Giant pulmonary bullae mimicking spontaneous pneumothorax 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. Follow-up 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 compressive atelectasis (Figure 1b). The patient underwent bullectomy of right bullae. The pa-tient 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 asymp-tomatic or chest distress. Bullectomy will be neces-sary when bullae lead to severe dyspnea or are infected.2 It can be a diagnostic challenge between pneumothorax and giant bullae. With pneumo-thorax, visceral pleural white line and convex sur-face 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