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Clinical Image
Giant Pulmonary Bulla Superinfection
Bulla pulmonar gigante sobreinfectada
Ana I. Córdoba Alonsoa,
Corresponding author
acordoba@humv.es

Corresponding author.
, Maite Arlabán Carpinterob, José M. Olmos Martíneza
a Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
b Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old man with no significant personal history consulted due to dyspnea and fever&#46; Clinical laboratory tests showed leukocytosis with left shift and elevated acute phase reactants&#46; Chest radiograph &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41; and computed tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41; showed a cystic image with calcified walls and air-fluid level&#44; occupying practically the entire right hemithorax&#44; causing parenchymal atelectasis&#44; and contralateral mediastinal shift&#46; Treatment began with empirical antibiotics&#44; and in view of the lack of response&#44; the collection was drained by thoracotomy&#44; with subsequent clinical improvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A giant pulmonary bulla is defined as an air space in the lung&#44; occupying over 30&#37; of the hemithorax&#46; Some risk factors include smoking&#44; chronic obstructive pulmonary disease&#44; and alpha-1 antitrypsin deficiency&#46; One of the complications is superinfection&#44; and various isolates have been reported &#40;methicillin-resistant Staphylococcus aureus&#44; Bacteroides&#44; Pseudomonas aeruginosa&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Bronchoscopy is not routinely indicated&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> However&#44; it is important to rule out a malignant etiology&#44; autoimmune disease&#44; primarily granulomatosis with polyangiitis&#44; sarcoidosis&#44; Sj&#246;gren syndrome&#44; and pulmonary embolism&#46; Drainage of the contents helps resolution&#44; due to the poor penetration of antibiotics into the cavity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; C&#243;rdoba Alonso AI&#44; Carpintero MA&#44; Olmos Mart&#237;nez JM&#46; Bulla pulmonar gigante sobreinfectada&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;395&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Standard posteroanterior and lateral chest radiographs showing cystic lesion with calcified walls occupying practically all the right hemithorax containing an air-fluid level&#46; &#40;C and D&#41; Chest computed tomography&#44; showing that the cystic lesion was causing atelectasis of a large part of the pulmonary parenchyma of the right hemithorax and left mediastinal shift&#46;</p>"
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                    0 => array:2 [
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                        0 => array:2 [
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                            1 => "S&#46;R&#46; Rose"
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                        "tituloSerie" => "Eur Respir J"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "L&#46;S&#46; Kirschner"
                            1 => "W&#46; Stauffer"
                            2 => "C&#46; Krenzel"
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                      "Revista" => array:6 [
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                        "volumen" => "111"
                        "paginaInicial" => "1772"
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                          0 => array:2 [
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Article information
ISSN: 15792129
Original language: English
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