Spontaneous resolution of a giant bulla in a patient presenting with COVID-19 with presumed superadded bacterial infection.

Abstract

Bullous emphysema is a chronic disease characterized by bullae, or air spaces in the lungs. Giant bullae exceed one-third of the hemithorax volume and are usually treated via bullectomy. We present the case of a 35-year-old man who presented to hospital with a history of COVID-19 infection and seven days of chest pain and dyspnoea. A giant left upper lobe fluid-filled bulla was identified on computed tomography. He was discharged with a course of antibiotics. A radiograph performed one month after presentation revealed an unchanged giant bulla. However, a chest radiograph and computed tomography nine months after initial presentation showed complete spontaneous resolution of the bulla. Bullectomy was deemed unnecessary. Cases of spontaneous bullae resolution, or autobullectomy, are rare. Our case implicates the role of infectious processes in autobullectomy. Serial imaging monitoring and delayed cardiothoracic assessment may be prudent to assess bullectomy necessity.