Bullae of Lung

image001It is not rare to have a lung bleb and bulla, which is normally noted on both lungs. Accompanied by soreness, pressure in the chest and other symptoms, bullae of lung can be caused by several conditions, including emphysema. If these bubble-like protuberances rupture, it can lead to a severe condition called pneumothorax. Read on to know the overview and consequence of this disease.

Overview of Bullae of Lung

Bullae or blebs are thin walled balloon-like sacs of air or gas in the tissue of the lung. Radiological tests, such as an X-ray or CT scan, can detect these sacs.


A giant bulla, due to its size, presents with obvious signs and symptoms. The signs and symptoms of the giant bulla can possibly include the following:

  • Soreness
  • Difficulty breathing in
  • Pressure in the chest area
  • Overall fatigue, due to the lack of oxygen
  • A bloated feeling

There are several signs and symptoms associated with disease, including:

  • Cyanosis
  • Pain in the upper part of the body
  • Dry coughs
  • Shortness of breath


Tall, thin young men are more likely to present with these sacs. The underlying conditions of bullae of lung can be:

  • Disease and injury to the lung
  • Chest wall trauma
  • Emphysema (Vesicular emphysema)
  • Tuberculosis
  • Anthracosilicosis
  • Lung tumors
  • Mediastinal new growth
  • Localized scar tissue
  • Oedema of bronchus

Consequence of Bullae of Lung – Pneumothorax

These bullae can rupture at any time, for example, they may rupture from changes in the air pressure when scuba diving, or even listening to loud music and from simply taking a sudden deep breath. Once the rupture occurs, immediately air or gas leaks into the pleural cavity, which creates pressure on the lungs and has a chance of leading to pneumothorax.

Risk Factors

  • Sex. Men are more likely than women to get this
  • Smoking. Even without emphysema, and depends on length of time, how many cigarettes etc
  • Lung disease. Having underlying disease, such as emphysema, pulmonary fibrosis, sarcoidosis, cystic fibrosis and others
  • History of pneumothorax. Within one to two years of a past episode and it can occur in the same lung or the other
  • Genetics. Certain types run in certain families
  • Age. If caused by ruptured air blisters, usually will appear between twenty to forty years old and tall and underweight men are more common as well
  • Mechanical ventilation. People who need mechanical ventilation are at a higher risk


  • Shortness of breath
  • Sharp chest pain, which is worse when breathing deep or coughing
  • Easily fatigued
  • Rapid heart rate
  • Tightening of the chest
  • Skin color turns bluish, due to the lack of oxygen
  • Flaring of the nostrils


A pneumothorax that is either injury related or disease related, can have the following complications:

  • Persistent air leak, this may require surgery, as the opening in the lung, sometimes will not close
  • Recurrence, within a year, a recurrence usually occurs
  • Respiratory failure
  • Shock
  • Cardiac arrest
  • Hypoxemia, which is low levels of oxygen in the blood


There is no definitive management course for initial pneumothorax. Physicians use risk stratification framework as well other approaches, in order to choose among the options available to restore lung volume and an air free pleural space as well as preventing recurrences. Medical therapeutic treatments include

  • Watching and waiting, with or without supplemental oxygen
  • Simple aspiration
  • Drainage of tube, with or without medical pleurodesis

Patients with pneumothorax may use the following medications to assist with the treatment:

  • Antibiotics, such as doxycycline
  • Local anesthetics, such as lidocaine and hydrochloride
  • Opioid anesthetics, such as fentanyl citrate and morphine
  • Benzodiazepines, such as lorazepam and midazolam

Operative therapy may be necessary if the patient has had several episodes of pneumothorax or if the lung remains unexpanded with a chest tube in for five days. Operative therapy includes the following:

  • Open thoracotomy
  • Laser treatment
  • Resection of blebs or pleura
  • Thoracoscopy, video assisted thoracoscopic surgery (VATS)
  • Electrocautery, Pleurodesis or sclerotherapy
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