Abstract
A 34-year-old black man presented to the emergency department with right-sided pleuritic chest pain, productive cough, low grade fever, and dyspnea. He had a history of emphysema, deep vein thrombosis, protein C and S deficiency, and inferior vena cava filter. His physical exam was significant for fever, tachypnea, tachycardia, and decreased breath sounds over the right upper and middle lung fields.We obtained a chest radiograph (Figure 1). Figure 1. Frontal chest radiograph demonstrating a large right upper lung bulla with internal layering of fluid.
Highlights
A 34-year-old black man presented to the emergency department with right-sided pleuritic chest pain, productive cough, low grade fever, and dyspnea
DIAGNOSIS Giant emphysematous bulla is defined as air-filled spaces that occupy more than one-third of the hemithorax and develops in a lung destroyed by generalized emphysema.[1]
A variety of procedures have been proposed, including local excision of the bullae, plication, stapler resection, lobectomy, and videothoracoscopy.2 Surgical therapy is indicated when patients have incapacitating dyspnea or for patients who have complications related to bullous disease, such as infection or pneumothorax.[3]
Summary
* University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida Supervising Section Editor: Sean Henderson, MD Submission history: Submitted March 4, 2013; Revision received March 25, 2013; Accepted March 25, 2013
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