For the past few days, a 75-year-old man with a history of chronic obstructive pulmonary disease had suffered from dyspnea and fever (temperature, 38.3°C [101°F]). He also complained of producing excessive foul-smelling sputum but denied any hemoptysis.
Examination of the lung was consistent with decreased air entry on the right upper lobe. The chest film revealed an air-fluid level in a large bulla in the right upper zone. Drs Sonia Arunabh and Navin Verma of Flushing, NY, report that this septic episode was caused by infection of this bulla, which responded to antibiotic therapy. As the patient's general condition improved, he was referred for surgical excision of the bulla.
Bullae are areas of marked focal dilatation of respiratory air space that result from coalescence of adjacent areas of emphysema. In addition to being prone to infection, these vesicles may enlarge and compress adjoining lung tissue, thus compromising respiratory function. Surgical resection of large, symptomatic bullae should be considered; this may allow the normal, compressed areas of the lung to reexpand and help resolve the patient's dyspnea.