Book contents
- Frontmatter
- Contents
- List of abbreviations
- Part I Fundamentals of CXR interpretation – ‘the basics’
- Part II A–Z Chest Radiology
- Abscess
- Achalasia
- Alveolar microlithiasis
- Aneurysm of the pulmonary artery
- Aortic arch aneurysm
- Aortic rupture
- Asbestos plaques
- Asthma
- Bochdalek hernia
- Bronchiectasis
- Bronchocele
- Calcified granulomata
- Carcinoma
- Cardiac aneurysm
- Chronic obstructive pulmonary disease
- Coarctation of the aorta
- Collapsed lung
- Consolidated lung
- Diaphragmatic hernia – acquired
- Diaphragmatic hernia – congenital
- Embolic disease
- Emphysematous bulla
- Extrinsic allergic alveolitis
- Flail chest
- Foregut duplication cyst
- Foreign body – inhaled
- Foreign body – swallowed
- Goitre
- Haemothorax
- Heart failure
- Hiatus hernia
- Idiopathic pulmonary fibrosis
- Incorrectly sited central venous line
- Kartagener syndrome
- Lymphangioleiomyomatosis
- Lymphoma
- Macleod's syndrome
- Mastectomy
- Mesothelioma
- Metastases
- Neuroenteric cyst
- Neurofibromatosis
- Pancoast tumour
- Pectus excavatum
- Pericardial cyst
- Pleural effusion
- Pleural mass
- Pneumoconiosis
- Pneumoperitoneum
- Pneumothorax
- Poland's syndrome
- Post lobectomy/post pneumonectomy
- Progressive massive fibrosis
- Pulmonary arterial hypertension
- Pulmonary arteriovenous malformation
- Sarcoidosis
- Silicosis
- Subphrenic abscess
- Thoracoplasty
- Thymus – malignant thymoma
- Thymus – normal
- Tuberculosis
- Varicella pneumonia
- Wegener's granulomatosis
Emphysematous bulla
Published online by Cambridge University Press: 25 February 2010
- Frontmatter
- Contents
- List of abbreviations
- Part I Fundamentals of CXR interpretation – ‘the basics’
- Part II A–Z Chest Radiology
- Abscess
- Achalasia
- Alveolar microlithiasis
- Aneurysm of the pulmonary artery
- Aortic arch aneurysm
- Aortic rupture
- Asbestos plaques
- Asthma
- Bochdalek hernia
- Bronchiectasis
- Bronchocele
- Calcified granulomata
- Carcinoma
- Cardiac aneurysm
- Chronic obstructive pulmonary disease
- Coarctation of the aorta
- Collapsed lung
- Consolidated lung
- Diaphragmatic hernia – acquired
- Diaphragmatic hernia – congenital
- Embolic disease
- Emphysematous bulla
- Extrinsic allergic alveolitis
- Flail chest
- Foregut duplication cyst
- Foreign body – inhaled
- Foreign body – swallowed
- Goitre
- Haemothorax
- Heart failure
- Hiatus hernia
- Idiopathic pulmonary fibrosis
- Incorrectly sited central venous line
- Kartagener syndrome
- Lymphangioleiomyomatosis
- Lymphoma
- Macleod's syndrome
- Mastectomy
- Mesothelioma
- Metastases
- Neuroenteric cyst
- Neurofibromatosis
- Pancoast tumour
- Pectus excavatum
- Pericardial cyst
- Pleural effusion
- Pleural mass
- Pneumoconiosis
- Pneumoperitoneum
- Pneumothorax
- Poland's syndrome
- Post lobectomy/post pneumonectomy
- Progressive massive fibrosis
- Pulmonary arterial hypertension
- Pulmonary arteriovenous malformation
- Sarcoidosis
- Silicosis
- Subphrenic abscess
- Thoracoplasty
- Thymus – malignant thymoma
- Thymus – normal
- Tuberculosis
- Varicella pneumonia
- Wegener's granulomatosis
Summary
Characteristics
Abnormal permanent enlargement of distal air spaces with destruction of alveolar walls ± lung fibrosis. Overlaps with chronic bronchitis to form a disease spectrum known as chronic obstructive pulmonary disease.
Due to an imbalance between lung proteases and anti-proteases.
A bulla is an avascular low attenuation area that is larger than 1 cm and has a thin but perceptible wall.
Associated with smoking but other chemicals and genetic disorders predispose to the condition (e.g. alpha-1 antitrypsin deficiency).
Three types of emphysema
Panacinar, centrilobular and paraseptal.
The different types of emphysema may coexist.
Clinical features
May be asymptomatic, early in the disease.
Exacerbations commonly precipitated by infection.
Cough, wheeze and exertional dyspnoea.
Tachypnoea, wheeze, lip pursing (a form of PEEP), use of accessory muscles (patients are referred to as pink puffers).
Signs of hypercarbia include coarse tremor, bounding pulse, peripheral vasodilatation, drowsiness, confusion or an obtunded patient.
Radiological features
CXR – focal area of well-defined lucency outlined with a thin wall. A fluid level may indicate infection within the bulla.
Other CXR features include hyperexpanded lungs with associated flattening of both hemi-diaphragms, ‘barrel-shaped chest’, coarse irregular lung markings (thickened dilated bronchi – chronic bronchitis overlaps) and enlargement of the central pulmonary arteries in keeping with pulmonary arterial hypertension.
REMEMBER to look for lung malignancy/nodules; a common association.
CT quantifies the extent, type and location of emphysema. It may also identify occult malignancy.
Differential diagnosis
Post-infective pneumatoceles.
Loculated pneumothorax.
Oligaemia secondary to pulmonary emboli or hilar vascular compression.
Management
Emphysematous bullae form part of a spectrum of chronic obstructive pulmonary disease (see p. 62).
Bullae in their own right usually need no active treatment. However, if severe disease, lung reduction surgery should be considered.
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- A-Z of Chest Radiology , pp. 90 - 91Publisher: Cambridge University PressPrint publication year: 2007