Radiographic Findings

The chest film shows bilateral pneumothoraces and bilateral upper lobe bullae. The right pneumothorax is somewhat difficult to appreciate adjacent to the multiple, large bullae. Note that compared to the prior chest radiographs, the small, left upper lobe bullae are more evident since the adjacent lung is now collapsed.

A CT shows a large, left pneumothorax with atelectatic lung, and smaller right pneumothorax with bullae.

Bilateral tube thoracostomies were performed for persistent air leaks. With nutritional support and a tapering of his corticosteroid dose, the left air leak resolved. After 6 weeks, he underwent a partial right upper lobectomy with resection of a broncho-pleural fistula.

Clinical summary Image 4

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