Chest Imaging

Bullous emphysema

emphysema associated with large bullae. It is generally seen in patients with centrilobular emphysema and/or paraseptal emphysema. On the basis of clinical and radiological features a syndrome of bullous emphysema or giant bullous emphysema has been defined. It is also referred to as vanishing lung syndrome or primary bullous disease of the lung. This entity is often seen in young men, and is characterized by the presence of large progressive, upper lobe bullae which occupy a significant volume of a hemithorax and are often asymmetrical (Fig.1).

On high resolution CT (HRCT) scans, the multiple large bullae measure from 1 to 20 cm in size. They are visible both in a subpleural location and within the lung parenchyma, but subpleural bullae predominate. Paraseptal emphysema is a predominant associated finding. CT is of value in the preoperative assessment of patients with bullous emphysema as it allows assessment of the extent of emphysema and the detection of findings of compression of the remaining lung parenchyma.

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Fig.1

a. Chest radiograph showing diffuse overinflation due to emphysema and the presence of two giant bullae in the right hemithorax. These bullae are distributed within the upper lobe and the lung basis. b. HRCT assessing the extent of bullous disease in the right lung and depicting compressive collapse of a part of the remaining lung parenchyma of the right lower lobe.
Bullous emphysema, Fig.1 (a)
Bullous emphysema, Fig.1 (b)