Giant bulla or pneumothorax: How to distinguish

Beatrice Aramini; Ciro Ruggiero; Alessandro Stefani; Uliano Morandi

doi:10.1016/j.ijscr.2019.08.003

Giant bulla or pneumothorax: How to distinguish

Int J Surg Case Rep. 2019:62:21-23. doi: 10.1016/j.ijscr.2019.08.003. Epub 2019 Aug 8.

Authors

Beatrice Aramini¹, Ciro Ruggiero², Alessandro Stefani³, Uliano Morandi⁴

Affiliations

¹ Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via Largo del Pozzo n. 71, 41124, Modena, Italy. Electronic address: beatrice.aramini@unimore.it.
² Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via Largo del Pozzo n. 71, 41124, Modena, Italy. Electronic address: ciro.ruggiero@unimore.it.
³ Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via Largo del Pozzo n. 71, 41124, Modena, Italy. Electronic address: alessandro.stefani@unimore.it.
⁴ Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via Largo del Pozzo n. 71, 41124, Modena, Italy. Electronic address: uliano.morandi@unimore.it.

Abstract

Background: The differential diagnosis between pneumothorax and giant bullae is thought to be straightforward but sometimes poses a challenge.

Case presentation: We present a case of a 54-year-old Caucasian man with a giant emphysematous bulla who underwent surgical resection. He had no smoking history and had previous pneumonia episodes. The surgery was free of complications, without air leaks, and he showed good ventilation of the lung.

Discussion: The main complications of bullae are pneumothorax, infection and hemorrhage. Pneumothorax is a serious complication in patients with compromised lung function. Therefore, it is very important to carefully distinguish bullae from pneumothorax to avoid iatrogenic pneumothorax in patients with bullous disease.

Conclusion: We emphasize how to differentiate between giant bullae and pneumothorax utilizing history, physical examination, and radiological studies, including computed tomography (CT) scan.

Keywords: Bullectomy; Chest drain; Giant bulla; Pneumothorax.