Presentation
Routine thoracic radiographs.
Patient Data
There are multiple thin-walled, air filled lucencies throughout the lungs. These bullae are visible on all projections. Bullae are best seen superimposed over the diaphragm on the lateral projections. There is incidental metal opacity in the body wall.
Case Discussion
These lesions are most consistent with congenital bullae or bronchogenic cysts.
Pulmonary bullae are occasional incidental findings on thoracic radiographs. They are thin-walled and often multiple, with distribution in many lung lobes. Thinner-walled lesions would be more compatible with emphysema, and thick or irregularly walled lesions are more likely to be infectious, neoplastic or parasitic in origin. Any bullous lesion can rupture and cause pneumothorax.
A list of potential differential diagnoses includes several disorders. The purely air-filled structure is most compatible with a bulla or cyst.
bulla (emphysema, congenital)
pulmonary cyst
bronchogenic cyst
parasitic (Paragonimus kellicotti)
abscess
pneumatocele (secondary to pneumonia or trauma)
neoplasia
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