Pulmonary Bleb

Aka: Pulmonary Bleb, Lung Bleb, Lung Bullae, Pulmonary Bullae

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II. Definitions

  1. Pulmonary Bleb
    1. Small (<1-2 cm), thin walled (<1 mm) air containing spaces within the lung
  2. Pulmonary Bullae
    1. Larger (>1-2 cm) air containing spaces within the lung
    2. A Pulmonary Bulla may be a coalescence of Pulmonary Blebs

III. Pathophysiology

  1. Blebs and Bullae form as a result of subpleural alveolar rupture

IV. Risk Factors

  1. Tobacco Abuse
  2. Thin Patient
  3. COPD

V. Differential Diagnosis

  1. Pneumatocele (post-Pneumonia)
  2. Pneumothorax
  3. Cystic Bronchiectasis
  4. Cavitary Lung Disease
  5. Cystic Lung Disease
    1. Lymphangioleiomyomatosis (LAM)
    2. Pulmonary Langerhans Cell Histiocytosis (PLCH)
    3. Birt-Hogg-Dube Syndrome (BHD)
    4. Lymphoid Interstitial Pneumonia (LIP)

VI. Complications

  1. Pneumothorax
  2. Bullae secondary infection
  3. Giant Bullous Emphysema (Vanishing Lung Syndrome)
    1. Large bullae, in some cases filling the entire hemithorax
    2. May impair lung function

VII. Resources

  1. Lung Bleb (Radiopaedia)
    1. https://radiopaedia.org/articles/pulmonary-bleb?lang=us

VIII. References

  1. Kumar and Kotloff (2018) Diagnostic Approach to the Adult with Cystic Lung Disease, UpToDate, accessed 8/5/2019
  2. Collins and Stern (2008) Chest Radiology, Wolters Kluwer, Philadelphia, p. 234-5

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