title: Tension bulla: a cause of reversible pulmonary hypertension.
abstract: A tension pneumothorax represents a medical emergency warranting urgent diagnosis and treatment. A rapidly expanding bulla may resemble the same clinical presentation but requires an entirely different treatment. A 53-year-old woman presented with increasing shortness of breath and her physical examination and chest x-ray were interpreted as showing a tension pneumothorax. A chest tube was placed which did not resolve the process. Placement of a second chest tube was likewise unsuccessful. A chest CT was then performed and was interpreted as showing an unresolved tension pneumothorax, despite seemingly adequate placement of the 2 chest tubes. Further review of the CT showed the border of a giant bulla and a tentative diagnosis was made of a rapidly expanding bulla with tension physiology. Echocardiogram revealed significant pulmonary hypertension. The bulla was surgically excised, the patient had marked improvement in her clinical symptoms and signs, and echocardiographic follow-up showed complete resolution of the pulmonary hypertension.
authors.affiliation: *Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS †Medical-Surgical Intensive Care Unit, Research Medical Center, Kansas City §St. Joseph Medical Center, Kansas City, MO ‡Mayo Clinic, Rochester, MN.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Waxman
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Waxman
authors.forename: John M
authors.initials: JM
authors.lastname: Forman
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology* / Q000628:therapy; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome