Multiple bullae in the upper lobes of both lungs

Multiple bullae in the upper lobes of both lungs is a relatively serious disease. We should get diagnosis and treatment in the hospital in time. We should pay more attention to lung care in our daily lives, but too much dust in our living environment may induce the formation of pulmonary bullae. We should pay attention to our respiratory health and eat more vegetables and fruits, which can have a certain protective effect on the lungs. So, what is the cause of multiple bullae in the upper lobes of both lungs?

1. Diagnosis

1. Chest X-ray

Thin-walled cavities of varying sizes and numbers can be seen in the lung field, with sparse lung texture or only linear shadows in the cavity. X-rays taken during maximal inspiration can determine the number, location, and true size of bullae. There may be compressed and dense lung tissue shadows around the bullae, and sometimes (such as when there is concurrent infection) fluid levels can be seen in the bullae cavity.

2. Chest CT

More accurate than X-rays. It can clearly display the size, number and range of bullae, observe bullae that are difficult to show on X-rays, clarify the boundary between bullae and lung parenchyma and whether there are other lung diseases, and help to differentiate between pneumothorax and bullae.

II. Treatment

Asymptomatic bullae do not require treatment. For patients with chronic bronchitis or emphysema, treatment is mainly focused on the primary lesion. If secondary infection occurs, antibiotics should be used. If the blister is large, occupying 70% to 100% of the chest cavity on one side, and the patient presents with respiratory distress, infection, and bleeding, it is an indication for surgery. Surgical removal of pulmonary bullae can re-expand the compressed lung tissue, increase the breathing area, eliminate intrapulmonary shunt, increase arterial oxygen partial pressure, reduce airway resistance, increase ventilation volume, and improve the patient's chest tightness, shortness of breath and other breathing difficulties symptoms. The principle of surgery is to remove the bullae and preserve healthy lung tissue as much as possible. In the case of bilateral bullae, when surgery is necessary, the more severe side should be removed first, and the other side can be operated on 6 months later if necessary. Spontaneous pneumothorax caused by ruptured bullae can be cured by non-surgical treatments such as thoracentesis and closed chest puncture, but recurrent spontaneous pneumothorax should be treated surgically.

3. Prevention

Two-thirds of the patients experienced significant improvement in symptoms after surgery. The better results are those with clear demarcations, significantly enlarged apical bullae that occupy at least 30% of the chest cavity. The postoperative efficacy of small, multiple bullae is relatively poor. Resection of pulmonary bullae (subpleural bullae) has little effect on lung function. For patients with intraparenchymal bullae without emphysema, the therapeutic effect can be maintained for a long time after surgery. However, for patients with intraparenchymal bullae and emphysema, the breath-shortness symptoms generally gradually return to the preoperative level 5 years after surgery. The main reason for not maintaining the therapeutic effect is the gradual worsening of emphysema. The 5-year improvement rate for such patients is 50%, and the 10-year improvement rate is 20%.