Pneumothorax vs Bulla

Q: What is the difference between Bulla and Pneumothorax?
A:
1) History:

• Bulla in 2 distinct populations:
  (1) emphysematous COPD (smoker)
  (2) congenital (younger, non smoker)
  
• Long duration of symptoms = Bulla
  

2) CXR:

• Vascular markings seen through "pneumo" area
• Non-anatomic contour of the pleural line; bleb
  
• Old CXR comparison

If in doubt, do Chest CT. Bedside US can also differentiate [Simon BC et al. JEM (2005) 29:201-5], plus anterior pneumothorax in the initial evaluation of the trauma patient may be detected where supine AP films miss it.

Treatment for large bulla is surgical removal with pleurodesis. It may enlarge after needle aspiration or chest tube drainage.

credit:
Swadron, Mastering Chest Radiography, ACEP lecture.