Thorax 1986;41:792-797 Large lung bullae in sarcoidosis

ABSTRACT Large lung bullae are a rare manifestation of pulmonary sarcoidosis. Of three patients with this complication, all had pulmonary infiltrates at presentation and two had bilateral hilar adenopathy. Hypercalcaemia developed during the course of the illness in all three patients. In each case the bullae had developed within four years of the diagnosis of sarcoidosis. In one woman a bulla resolved almost completely after it had become infected. Persistence of pulmonary infiltration in sarcoidosis may lead to irreversible lung fibrosis. ' This fibrosis becomes evident on the chest radiograph with the ap-pearance of retraction, distortion, and shrinkage of the lung parenchyma. These changes are often accom-panied by the presence of small to moderate sized bullae and cavities within strands of fibrosis. May-cock et al2 reviewed the radiological appearances in 145 patients with pulmonary sarcoidosis and found small and moderate sized bullae in 5-8 % of patients. In a series of 300 cases bullae were present in 26-9% of black and 13-5 % of white patients.3 More rarely, large lung bullae may develop in sar-coidosis, again usually in association with gross fibrotic change.4 5 Miller6 has further identified a sub-group of patients with pulmonary sarcoidosis who develop radiological signs of generalised emphysema, usually with large bullae, and with little evidence of fibrosis. He described two such cases of his own and two other cases have been reported.7 8 In this report we describe three patients with sarcoidosis who developed large lung bullae at an early stage after diagnosis. Case reports CASE I A 40 year old symptomless woman, a lifelong non-smoker, was admitted to hospital in 1971 for investig-ation because of an abnormal chest radiograph. Physical examination revealed enlarged supra-clavicular nodes bilaterally but no other abnormality