A 64-year-old man presented to the emergency room with shortness of breath for 3 days. He has a history of COPD for 8-9 years but no other medical conditions. On examination, he had an elevated heart rate, decreased breath sounds, crackles on lung auscultation, and severe breathlessness. A chest X-ray showed bullae or possible pneumothorax on the right side. Bullae are air-filled spaces within the lung tissue caused by emphysema. Treatment options for bullae include surgical removal or bronchoscopic methods, but there is a risk of bronchopleural fistula. If the chest X-ray is unclear whether bullae or pneumothorax are

1. 64 Yrs old Man presented to ER
c/o SOB * 3 days
No h/o fever,
No HTN / DM
k/c/o – COPD since 8-9 yrs,
O/E :-
CVS – 105/min
R/S – ↓ breath sounds , hyper resonance on percussion
b/l crepts +, wheeze aslo
severely breathlessness

2. CXR
Emergency CXR was done
Right side
Bullae or pneumothorax

3. CXR on 28th

4. Post ICD CXR

5. ▪ Bullae are defined as sharply demarcated, air-filled spaces within the
parenchyma of the lung, measuring one centimetre or greater in distended
diameter, which are formed as a result of the destructive process of
emphysema or alpha 1 antitrypsin deficiency.
Mx:
Treatment options include surgical bullectomy and several transbronchial
bronchoscopic methods
Risk:-
▪ BPF - a BPF is a communication between a main stem, lobar, or
segmental bronchus and the pleural space

6. Take home message
▪ If in doubt whether it’s Bullae or Pneumothorax- Do an CXR
If visceral pleural line present consider Pneumothorax.
If no visceral pleural line do further imaging(CT) to rule out Bullae.