CTICasesGiant Bullous Emphysema Misinterpreted as Pneumothorax
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Imaging findings
A trauma patient presented with a chest radiograph showing a large area of lucency in the right lung with significant mediastinal shift, initially interpreted as a tension pneumothorax. However, subtle peripheral lung markings were still visible, and a clear visceral pleural white line was absent. Subsequent CT confirmed giant bullous emphysema. After insertion and removal of a chest tube, a true iatrogenic pneumothorax developed, clearly demonstrating a visceral pleural line and absence of lung markings.
Key takeaways
It is crucial to differentiate large bullous emphysema from pneumothorax, especially in trauma settings. Key differentiating features include the presence of residual vascular markings within the lucent area and the absence of a distinct visceral pleural line in emphysema. Incorrect chest tube placement into a bulla can lead to iatrogenic pneumothorax upon removal.
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