Percutaneous drainage of a fluid-containing emphysematous bulla

We present the case of a 38-year-old man, with congenital bullous emphysema, who presented with unilateral pleuritic chest pain, rigors and a non-productive cough. A chest X-ray on admission demonstrated extensive bilateral bullous lung disease with left-sided lung collapse. There were fluid levels present within several bullae, with the largest bulla compromising most of the posterior aspect of the left lung base. We suspected infected emphysematous bullae. Despite prolonged conservative management with antibiotics the patient deteriorated clinically, consistently spiking temperatures and desaturating. Repeat imaging demonstrated further accumulation of fluid in the largest bulla. A small bore chest drain was inserted into this bulla under ultrasound guidance, draining 550 mL of pulmonary fluid. The patient stabilised clinically and was discharged. He remained well after completing six weeks of intravenous antibiotics in the community.