Air-fluid levels within lung bullae associated with pneumonitis

Abstract

Although air-fluid levels occur commonly within lung bullae, this entity in association with non-tuberculous pneumonitis has received neither adequate nor recent emphasis. We observed ten male patients with pre-existing bullous disease whose chest radiographs showed a pulmonary infiltrate adjacent to thin-walled air space(s) with one or more air-fluid levels. Six patients were symptomatic and only one was acutely ill. Fiberoptic bronchoscopy (8/10 patients) revealed no evidence of endobronchial disease, tuberculosis, or cancer. Air-fluid levels disappeared within 3 days to 36 weeks (mean, 11 weeks), while the alveolar infiltrate cleared at a slower rate. Although the mechanism of fluid formation within a bulla is unknown, it may be analogous to the development of a parapneumonic pleural effusion. Fiberoptic bronchoscopy is useful to exclude the presence of an obstructing endobronchial lesion and to obtain secretions for cytology and culture of specific organisms. Recognition of this entity is important since radiographic resolution can be expected to be slow and surgical intervention is unnecessary.