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J Bronchology Interv Pulmonol. 2015 Jan;22(1):69-72. doi: 10.1097/LBR.0000000000000131.

Tension bulla: a cause of reversible pulmonary hypertension.

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*Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS †Medical-Surgical Intensive Care Unit, Research Medical Center, Kansas City §St. Joseph Medical Center, Kansas City, MO ‡Mayo Clinic, Rochester, MN.


A tension pneumothorax represents a medical emergency warranting urgent diagnosis and treatment. A rapidly expanding bulla may resemble the same clinical presentation but requires an entirely different treatment. A 53-year-old woman presented with increasing shortness of breath and her physical examination and chest x-ray were interpreted as showing a tension pneumothorax. A chest tube was placed which did not resolve the process. Placement of a second chest tube was likewise unsuccessful. A chest CT was then performed and was interpreted as showing an unresolved tension pneumothorax, despite seemingly adequate placement of the 2 chest tubes. Further review of the CT showed the border of a giant bulla and a tentative diagnosis was made of a rapidly expanding bulla with tension physiology. Echocardiogram revealed significant pulmonary hypertension. The bulla was surgically excised, the patient had marked improvement in her clinical symptoms and signs, and echocardiographic follow-up showed complete resolution of the pulmonary hypertension.

[Indexed for MEDLINE]

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