Images in Clinical Medicine
Kim Eagle, M.D., Editor
Inflammatory Autobullectomy
N Engl J Med 1996; 334:1372-1373May 23, 1996
- Article
Figure 1 A 43-year-old man with bullous emphysema was admitted to the hospital with pneumonia. On admission a chest film (Panel A) showed a bulla (white arrow in Panels A through G), which had also been present 15 months earlier, adjacent to right-lower-lobe pneumonia (thick black arrow in Panel A and Panel B). After three days of antibiotics, an air-fluid level (thin black arrow in Panel B, Panel C, Panel D, and Panel E) developed within the bulla (Panel B). The clinical symptoms and the right-lower-lobe infiltrate resolved (Panel C) during the ensuing six-week course of amoxicillin at a dose of 500 mg orally three times a day, but the air-fluid level persisted (Panel D and Panel E). The patient was followed clinically, with no further antibiotics. Over time, the bulla diminished in size (Panel D, Panel E, and Panel F), finally resulting in only a small, pleural-based scar (Panel G).
This case illustrates the commonly occurring process of a parapneumonic effusion within a bulla adjacent to an area of pneumonia and the rare shrinkage of a bulla, which probably results from the inflammatory process within the bulla and obstruction of the bronchus supplying it.
Kim Eagle, M.D.
Richard B. Goodman, M.D.
S. Lakshminarayan, M.D.
Veterans Affairs Medical Center, Seattle, WA 98108
