Complete resolution of the giant pulmonary bulla: a case of inflammatory autobullectomy

Abstract

Giant pulmonary bulla (GPB), first described by Burke in 1937, is a rare clinical and radiological manifestation which usually occurs in the upper lobes of the lung. 1-3 GPB commonly increases in size over time and develops into respiratory symptoms commonly caused by a pneumothorax or by the compression of the adjacent lung. 2,4 According to these characteristics of GPB, it is clinically accepted that patients with GPB will greatly benefit from a surgical intervention: bullectomy. 5,6 However, few case reports have been reported to show the complete resolution of GPB after the inflammatory process, such as an infected bulla or peribullous pneumonia, without any additional interventional procedure or surgery. 7 Herein, we present a rare case of a complete resolution of GPB after the inflammatory process without the administration of any further interventional procedure or surgical resection.Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.