Regression of Large Lung Bullae after Peribullous Pneumonia or Spontaneously

Eun Young Choi; Woo Sung Kim

doi:10.4046/trd.2012.72.1.37

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Choi and Kim: Regression of Large Lung Bullae after Peribullous Pneumonia or Spontaneously

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(1): 37-43.

Published online: 30 January 2012

DOI: https://doi.org/10.4046/trd.2012.72.1.37

Regression of Large Lung Bullae after Peribullous Pneumonia or Spontaneously

Eun Young Choi, M.D.^1,², Woo Sung Kim, M.D., Ph.D.¹

¹Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Address for correspondence: Woo Sung Kim, M.D., Ph.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3133, Fax: 82-2-3010-6968, wskim2@amc.seoul.kr

Received 4 July 2011 Revised 18 November 2011 Accepted 18 November 2011

Abstract

Background

A lung bulla may rarely shrink as a result of an inflammation within the bulla or a closing of a bronchus involved in the inflammation process, which is termed 'autobullectomy'. The purpose of this study was to describe clinical features of patients with regressions of bullae during follow-up.

Methods

We retrospectively reviewed the cases and individuals who showed unequivocal evidence of interval regressions in a pre-existing bulla. A total of 477 cases with a bulla >5 cm in diameter were screened manually. Thirty cases with bullae that showed regression during follow-up were selected.

Results

Regressions of large bullae occurred in 30 of 477 cases (6.3%). The median age of those patients was 61 (range, 53~66) years and 87% of those patients were men. The main cause of a bulla was emphysema (80%). Among 30 cases, 16 cases had pneumonia in the lung parenchyma of the peribullous area. Another 7 cases had a regressed bulla accompanied by an air-fluid level within the bulla. The remaining 7 cases showed a spontaneous regression of the bulla without such events. Complete regression of a bulla occurred in 25 cases. A follow-up chest-X ray showed that in all cases except one, the bulla remained in a collapsed state after 24 months. Forced expiratory volume in one second (FEV₁) improved in 3 cases and the other 2 cases had increased forced vital capacity (FVC). In addition, total lung capacity (TLC) and residual volume (RV) decreased in another 2 cases.

Conclusion

Regression of a lung bulla occurred not only after pneumonia or the presence of air-fluid level within the bulla, but also without such episodes. The clinical course of regression of a lung bulla varied. After regression of a bulla, lung function could be improved in some cases.

Keywords: Blister, Remission, Spontaneous, Radiography, Pulmonary Emphysema

Figures and Tables

Figure 1

Serial chest radiographic changes in a patient diagnosed with pneumonia with air-fluid level. (A) One month prior to admission. (B) At admission with pneumonia. (C) Five days later. (D) One year later.

Figure 2

Complete regression of a bulla in a patient without any episode of respiratory disease during follow-up. (A) Initial chest radiograph. (B) One year later.

Figure 3

Clinical course of the 3 groups of patients with large lung bullae.

Table 1

Baseline characteristics of patients with autobullectomy

Data are presented as number or number (%).

IQR: interquatile range; PFT: pulmonary function test.

Table 2

Clinical features at the episode of autobullectomy

Data are presented as number or number (%).

^*Complete: completely disappeared bulla on chest radiograph, ^†Near complete: reduced size on chest radiograph but not completely disappear.

WBC: white blood cell; AFB: acid fast bacilli; PCD: percutaneous drainage.

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