| 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 |
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 |
| One is a bulla | |
| Two or more are bullae (bully) | |
| Diseases which contain bullae are bullous diseases |
| What is a singular tic called? | |
| What is the pleural of femur? | |
| What is the pleural of tibia? | |
| What is the pleural of esophagus? |
| Enlarge progressively over a period of months to years | |
| Most are associated with emphysema | |
| May become infected or lead to pneumothorax |
| Familial occurrence | ||
| Increased incidence in Marfan's and Ehlers-Danlos | ||
| No airway obstruction and normal parenchyma between bullae | ||
| Unlike emphysema | ||
| Originate in a subpleural location usually in upper part of lung | |
| Narrow neck | |
| Produce passive atelectasis of adjacent lung tissue | |
| Paraseptal emphysema |
| 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 |
| Lie deep within lung substance | |
| Like type 2, contain residual strands of lung tissue | |
| Affect upper and lower lobes with same frequency |
| 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 | ||
| 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 | ||
Bullous Disease
Spontaneous Pneumothorax
| Commonly occurs with small bulla affecting lung apices | ||
| May be difficult to differentiate large bulla from PTX | ||
| CT may help | ||
| 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 |