bubble_chart Overview

On the basis of inflammation, bronchiolar dysplasia, or lung qi swelling, the alveoli on the surface of the lungs form giant cystic changes due to increased internal pressure, known as pulmonary bullae. Pulmonary bullae can be congenital or acquired. Congenital cases are more common in children, caused by congenital bronchiolar dysplasia, where the mucosal folds form a valve-like membrane, and cartilage dysplasia. If inflammation, edema, or mucus blockage occurs in the bronchioles, a local valve effect forms, increasing the internal pressure in the alveoli and leading to pulmonary bullae. Acquired pulmonary bullae are more common in middle-aged and elderly patients, often associated with chronic bronchitis and lung qi swelling. The number, size, and distribution of pulmonary bullae vary among individuals. Large tension bullae can occupy one side of the thoracic cavity, compressing lung tissue and pushing the heart, trachea, and mediastinum toward the opposite side, or forming a mediastinal lung hernia protruding into the opposite thoracic cavity. Clinically, this manifests as progressive dyspnea, cyanosis, and heart failure. Pulmonary bullae may also rupture, leading to spontaneous pneumothorax. For congenital pulmonary bullae in children, surgical treatment may be considered if symptoms are present or if there are recurrent episodes. In adults, surgical intervention is also recommended for pulmonary bullae causing respiratory distress, infection, bleeding, or recurrent pneumothorax. Surgical treatment is effective and reliable.

bubble_chart Clinical Manifestations

1. Most have a history of chronic bronchitis.
2. There is progressive dyspnea.
3. The affected area shows diminished or absent breath sounds, with tympany on percussion.
4. If the lesion is massive, the trachea and heart may be displaced to the opposite side.

bubble_chart Diagnosis

1. Progressive dyspnea.
2. Diminished or absent breath sounds at the lesion site, tympany on percussion, trachea and heart displaced to the opposite side.
3. Chest X-ray: Single or multiple bubble-like lucent areas in the lungs, with no lung markings inside the bubbles and thin walls. Compressed dense lung markings may be seen around the bubbles.

bubble_chart Treatment Measures

1. For congenital pulmonary bullae in children, surgical treatment may be considered if symptoms are significant or recurrent. If the pulmonary bullae are secondary to inflammation, the primary approach is to control the inflammation with medication. If the bullae do not shrink or disappear after inflammation control, surgical intervention may also be considered.
2. In adults, pulmonary bullae that cause respiratory distress, infection, hemorrhage, or recurrent pneumothorax should be treated surgically.
3. The surgical principle is to excise the bullae while preserving as much healthy lung tissue as possible.
4. For bilateral pulmonary bullae requiring surgery, the more severe side should be addressed first, with the other side potentially operated on six months later if necessary.

The formation, enlargement, and critical episodes of pulmonary bullae are all related to inflammation and bronchial mucosal edema and obstruction. Therefore, controlling inflammation and relieving bronchial mucosal edema and obstruction are crucial during treatment. Pulmonary bullae presenting with respiratory distress, infection, hemorrhage, or recurrent pneumothorax should be surgically treated as early as possible. For giant pulmonary bullae compressing vital intrathoracic organs and causing respiratory or circulatory crises, immediate intrathoracic decompression must be performed on-site to save the patient's life. In such cases, moving the patient must be avoided to prevent worsening hypoxia and triggering respiratory or cardiac arrest.

bubble_chart Cure Criteria

1. Cured: Symptoms and signs have disappeared, with good expansion of the remaining lung.
2. Improved: Symptoms and signs have shown improvement.
3. Not cured: Symptoms have not improved.