title: Localized Hyperlucency in an Acutely Dyspneic Patient: Always a Pneumothorax?
abstract: BACKGROUND
  Every emergency physician encounters acutely dyspneic patients with localized hyperlucency on chest x-ray study. Although most commonly due to pneumothorax, alternative diagnosis in selected cases with atypical features includes bullae and cystic lesions, especially in childhood. Presence of atypical radiology shouId alert an emergency physician to rule out any alternative diagnosis. Computed tomography is usually diagnostic in such cases and a double-wall sign on computed tomography aids to distinguish between pneumothorax and bullous disease.
  
  
  METHODS
  A 60-year-old male presented with sudden increase in dyspnea and a localized hyperlucency on chest x-ray study. A review of his medical records and evaluation of atypical radiology by computed tomography revealed increase in size of bulla to be the cause for distress rather than a pneumothorax. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Every emergency physician encountering acutely dyspneic patients should be aware of these potential mimickers of pneumothorax and ways to distinguish them to avoid inadvertent tube thoracostomy and possible complications.
authors.affiliation: Department of Pulmonary Medicine, Aiims Rishikesh, Uttarakhand, India.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Dua
authors.affiliation: Department of Pulmonary Medicine, Aiims Rishikesh, Uttarakhand, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Singhal
mesh_terms: D001768:Blister / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging*; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
keywords: bullous disease; localized hyperlucency; pneumothorax