What Is Bullous Emphysema?

Pulmonary bullae refers to a balloon-containing cavity formed in the lung tissue due to increased pressure in the alveolar cavity due to various reasons, alveolar wall rupture, fusion with each other. There are two types of pulmonary bullae, congenital and acquired. Congenital is more common in children, due to congenital bronchial abnormalities, mucosal folds are valvular, and cartilage dysplasia is caused by valve action. Acquired is more common in adults and elderly patients, often with chronic bronchitis and emphysema. At present, most of the bullous surgery can be performed under the video-assisted thoracoscopy, and 2/3 of the patients' symptoms have improved significantly.

Basic Information

Also known as: Bullae
English name: bullae
Visiting department: Respiratory

Common locations: lung
Common causes: "Most secondary to inflammatory lesions of the lung and bronchus, a few are congenital"
Common symptoms: Cough, chest tightness, shortness of breath, difficulty breathing

Causes of bullae

Pulmonary bullae are usually secondary to inflammatory lesions of the small bronchus, such as pneumonia, tuberculosis, or emphysema, and there are some idiopathic idiopathic bullae. After the inflammatory lesions of the small bronchus appear edema and stenosis, the lumen is partially blocked, producing a valve effect, allowing air to enter the alveoli but not being expelled, resulting in increased pressure in the alveolar cavity; at the same time, inflammation causes damage to the lung tissue, alveolar walls and spaces Gradually rupture due to increased intravesicular pressure, the alveoli fuse with each other to form a large balloon-containing cavity. There are single and multiple bullae. Those who are secondary to pneumonia or tuberculosis are usually single; those who are secondary to emphysema are often multiple, and the boundaries of bullae and emphysema-like lung tissue are often unclear. Emphysema with obvious bullae is also called bullous emphysema.

Clinical manifestations of bullae

Smaller, smaller numbers of simple bullae may be asymptomatic and sometimes only incidentally detected on chest radiographs or CT scans. Some bullae can remain unchanged for many years, and some bullae can gradually increase. The enlargement of bullae or new bullae in other parts can cause lung dysfunction and gradually develop symptoms. Large or multiple bullae may have symptoms such as chest tightness and shortness of breath. In particular, patients with giant pulmonary bullae whose volume exceeds one-half of the chest volume, or patients with chronic obstructive pulmonary disease often have symptoms such as chest tightness and shortness of breath. Infection within the bullae can cause cough, sputum, chills, and fever, with cyanosis in severe cases. A few patients with bullae have symptoms such as hemoptysis and chest pain.

Bullae examination

Chest x-ray

Is the best way to diagnose bullae. Pulmonary bullae appear as thin, translucent cavities located at the edge of the lung field. They can be round, oval, or flattened rectangles, of varying sizes. In larger bullae, sometimes transverse At intervals, multiple bullae may come together in a polyhedral shape. Generally, they do not directly communicate with the larger bronchi, and they are flat.

2.CT inspection

It can be found that common chest radiographs under the pleura have a bullae with a diameter of less than 1 cm.

3. Pulmonary angiography

It can accurately show the degree of pulmonary blood vessel damage and the condition of the blood vessels around the bullae.

Bullae diagnosis

Chest x-ray

It can be seen that there are thin-walled cavities of varying sizes and numbers in the lung field, and the lung texture in the cavity is sparse or has only strand-like shadows. X-rays taken at maximum inspiration can determine the number, location, and true size of bullae. Complicated and dense shadows of lung tissue may be present around the bullae, and sometimes (such as co-infection) fluid levels are visible in the blister cavity.

2. Chest CT

More accurate than X-rays. It can clearly show the size, number and scope of bullae, observe bullae that are difficult to show on X-rays, determine the boundaries between bullae and lung parenchyma, and whether they are accompanied by other lung diseases, and help identify pneumothorax and bullae.

Bullae treatment

Asymptomatic bullae does not require treatment, and patients with chronic bronchitis or emphysema are mainly treated for primary lesions. For secondary infections, antibiotics are used. The blisters are large, occupying 70% to 100% of one side of the thorax, and clinically, patients with respiratory distress, infection, and bleeding are all indications for surgery. Surgical removal of bullae can recompress the compressed lung tissue, increase the breathing area, disappear the intrapulmonary shunt, increase the arterial oxygen pressure, reduce airway resistance, increase ventilation, and improve symptoms such as chest tightness and shortness of breath. The principle of surgery is to remove the bullae and try to preserve healthy lung tissue. For bilateral bullae, when more surgery is necessary, the more severe side should be removed first, and the other side should be performed after 6 months if necessary. Spontaneous pneumothorax caused by ruptured pulmonary bullae can be cured by non-surgical treatment such as thoracentesis and closed chest flow, but spontaneous pneumothorax that occurs repeatedly should be treated surgically.

Bullae prevention

Symptoms improved significantly in 2/3 of patients. Those with better results were clear-cut, markedly enlarged apical bullae, and occupied at least 30% of the thorax. The efficacy of small, multiple bullae is relatively poor after surgery. Pulmonary blister (subpleural bullae) resection will not affect lung function. Those with intrapulmonary bullae without emphysema can maintain long-term efficacy after operation. However, in patients with parenchymal pulmonary emphysema and emphysema, the symptoms of radon gradually reach the preoperative level within 5 years after operation. The main reason for not being able to maintain the effect is the gradual increase of emphysema. The 5-year improvement rate of such patients is 50% The 10-year improvement rate is 20%.