1	Bullous Disease Of the Lungs
2	Bullae For You
3	What a Bulla Is Definition Thin-walled–less than 1 mm Air-filled space In the lung > 1 cm in size when distended Walls may be formed by pleura, septa, or compressed lung tissue
4	What a Bulla Isn’t Other Terminology Pneumatocoele: thin-walled (< 1mm), gas-filled space in the lung developing in association with acute pneumonia, usually staph, and usually transient Cavity: gas-containing space in the lung having a wall > 1 mm thick Cyst: thin-walled, air- or fluid-filled, with a wall that contains respiratory epithelium, cartilage, smooth muscle and glands Bleb: intrapleural cystic space, uncommon
5	Bulla Terminology One is a bulla Two or more are bullae (bully) Diseases which contain bullae are bullous diseases
6	Other Latin What is a singular tic called? What is the pleural of femur? What is the pleural of tibia? What is the pleural of esophagus?
7	Bullae General Enlarge progressively over a period of months to years Most are associated with emphysema May become infected or lead to pneumothorax
8	Primary Bullous Disease Familial occurrence Increased incidence in Marfan's and Ehlers-Danlos No airway obstruction and normal parenchyma between bullae Unlike emphysema
9	Types of Bullae Type 1 Originate in a subpleural location usually in upper part of lung Narrow neck Produce passive atelectasis of adjacent lung tissue Paraseptal emphysema
10	Types of Bullae Type 2 Superficial in location Very broad neck Anterior edge of upper and middle lobes and along diaphragm Contain blood vessels and strands of partially destroyed lung Spontaneous pneumothorax
11	Types of Bullae Type 3 Lie deep within lung substance Like type 2, contain residual strands of lung tissue Affect upper and lower lobes with same frequency
12	Bullae Radiologic Signs Seen more in upper lobes Thin-walled, sharply demarcated areas containing no visible blood vessels Only portion of wall is usually seen Trap air Larger on expiration
13	Infected Bullae Signs Air-fluid level Differentiation from lung abscess Bulla contains less fluid Much thinner wall No surrounding pneumonitis Patients less sick with infected bulla Clearing may take weeks to months
14	Bullous Disease Spontaneous Pneumothorax Commonly occurs with small bulla affecting lung apices May be difficult to differentiate large bulla from PTX CT may help
15	Bullous Disease Clinical 1° bullous disease usually has no symptoms When large, surgical removal may be performed Patients with COPD show little difference clinically or functionally with or without bullae