PMC3700969_01
(A) Chest radiograph prior to admission showing hyperinflated lungs, biapical bullous disease as evidenced by lucency without lung markings (black arrows). Note inferior border of bullae is seen (double white arrows). (B) Computer tomography at admission with coronal reformatted images confirms the bullous disease (black arrows); inferior border of bullae (double white arrows).
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A chest x-ray (CXR) taken in November 2006 (Fig. 1A) showed hyperinflated lungs with bilateral upper lobe bullae, which was again seen by computed tomography on admission (Fig. 1B).
Serial chest radiographs showing (A) air fluid levels in left upper lobe bullae (black arrows). Over the course of 3 months the left upper lobe bullae air fluid level decreases with concurrent development of new air fluid level with in right apical bullae (double white arrow) (B and C).
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The CXR showed bilateral bullae, with an air fluid level on the left side (Fig. 2A), and the CT-scan of the chest confirmed multiple bilateral upper lobe bullae with air fluid levels in the left upper lobe bullae. A follow-up chest x-ray 2 weeks after discharge revealed bilateral bullae with air fluid levels on the left and a new air fluid level on the right (Fig. 2B). Given this information, he was still not a candidate for any type of surgical intervention, but the antibiotics course was continued. 6 weeks after the patient was discharged, the chest x-ray showed a resolution of the left apical air-fluid level and an expansion of the right sided bullae, with a larger air fluid level (Fig. 2C).
Chest radiograph at 4 month follow-up from admission, the inferior edge of bilateral apical lung bullae has now returned superiorly (double white arrows), indicating the auto collapse of bullae bilaterally (A). Computer tomography confirms the chest radiograph finding (B), lower borders of the bullae have arisen (double white arrows).
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A chest x-ray revealed a complete resolution of all air fluid levels and bullae (Fig. 3A), confirmed by CT-scan (Fig. 3B).
Computer tomography performed one year later shows no change in the growth of the apical bullae.
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A long-term follow-up CT-scan at 16 months (July 2012) revealed no change in the radiographic findings from the CT-scan done at the 4-month follow up appointment (Fig. 4).