Emphysema and Disorders of the Pleural Cavity

Abstract

Bullous emphysema is a disorder in which the lungs contain bullae that are not associated with an intrinsic disease of the airways or with pulmonary scarring from a disease such as tuberculosis. For surgical purposes, a bulla is defined as an emphysematous space, not lined by epithelium, with a roof formed by visceral pleura. Most single bullae that occupy less than one-third of a thoracic cavity and that are situated in otherwise normal lungs do not cause symptoms. A large bulla, however, can compress and compromise the function of the rest of the lung. In addition, a bulla can cause a relaxation of the adjacent lung, thereby decreasing the radial tension on airways and causing an increased resistance to airflow. A bulla can become infected; the lung can bleed into a bulla, occasionally causing life-threatening hemoptysis; and a bulla can rupture, producing a pneumothorax.