J Punjab Acad Forensic Med Toxicol 2012;12(1):48

Case Study
BULLOUS EMPHYSEMATOUS LUNGS- A CASE REPORT
Dr. Bindu Aggarwal, Reader, Department of Anatomy, National Dental College, Gulabgarh, Mohali.
Dr. Sanjay Singla. Medical Officer, Department of Cardiology, Govt. Medical College, Patiala, Punjab
Dr. Monika Garg, Associate professor, Department of Pathology, MMIMSR, Mullana, Haryana
Dr. RK Gorea, Professor Forensic Medicine and Toxicology, Principal, Rama Medical College, Hospital and
Research Center, Kanpur UP
Article history

Abstract

Received Jan 01, 2012

Received in revised form May 08,
2012
Accepted on May 12, 2012
Available online June 25, 2012

Emphysema is a condition of the lungs characterized by an

abnormal increase in the size of the airspaces distal to the
terminal bronchiole. Bullous emphysema is where one or more
thin-walled, air-containing spaces are conflated by ruptured
pulmonary alveoli. These thin-walled air sacs in lung tissue
termed as bullae have a tendency to burst. In the present study,
Corresponding author
emphysematous lungs were found in a male cadaver during
dissection in the department of Anatomy at Gian Sagar Medical
Dr. Bindu Aggarwal
College, Banur, Patiala. The right and left lungs had multiple bullae
ranging from 1.5- 3 cm in diameter. In emphysematous lungs, the
Phone: +919855126677
rupture of the bullae can cause symptoms of respiratory distress
due to collapse of lung. The emphysematous lung can burden the
Email: drbindusanjay@gmail.com
heart causing heart- failure and sudden death.
Keywords: Emphysema; bullae; lungs; sudden death
2012 JPAFMAT. All rights reserved
Introduction
Emphysema is defined as a condition of
the lungs characterized by an abnormal increase
in the size of the airspaces distal to the terminal
bronchiole.[1] The increase in airway size can
be caused by an inherited predisposition
observed in 1-antitrypsin deficiency.[2] An
estimated 50,000 to 100,000 Americans
currently have this enzyme deficiency. Smoking
is responsible for 82% of all chronic obstructive
pulmonary
disease
(COPD),
including
emphysema. An estimated 2 million Americans
suffer from emphysema. [3]
Bullous emphysema is when one or more thinwalled, air containing spaces are conflated by
ruptured pulmonary alveoli. Bullae can be small
or giant. Patients with severe bullous
emphysema often experience difficulty in
breathing, chronic cough, chest pain and
cyanosis. If the bullae burst, it produces severe
symptoms including lung collapse.[4] It was
documented on the basis of clinical course and
autopsy observations that the right ventricle is
burdened in emphysema, probably due to
elevation in pulmonary pressure leading to
heart failure and death.[5]
Case Report
In the present study, emphysematous
lungs were found in a male cadaver during
dissection in the department of Anatomy at Gian
Sagar Medical College, Banur, Patiala. The right
and left lungs had multiple bullae. The size of

the bullae ranged from 1.5- 3 cm in diameter.

Giant bullae (2.5-3cm) were present along the
anterior border of the right lung (Fig 1)

Fig 1. Showing Bullous right lung.

and along the anterior border of left lung (Fig
2). A ruptured bulla was found at the apex of the
right lung. The lung tissue from the apical region
was subjected to histo-pathological study. The
report confirmed a ruptured air filled bulla
measuring 2.5x1x1 cm. The bulla was lined by
visceral pleura and contained emphysematous
areas with complete destruction of lung tissue.
Discussion
In the present study, emphysematous
lungs with multiple bullae were found in a male
cadaver during dissection. In Uganda, 23.5%
emphysematous lungs were found on autopsy

J Punjab Acad Forensic Med Toxicol 2012;12(1):49

by Jones [6]. Lobar emphysema was detected by

Saxton [7] in an infant radiologically. Male
gender, age, smoking habit, and grade of the
anthracosis are the factors that affect the
development of emphysema. [8]

4.
5.
6.
7.
8.

9.

10.
Fig 2. Showing Bullous left lung.
It was reported on an autopsy-based study of
131 cases in Turkish population [9] that most
patients with bullous emphysema are cigarette
smokers. The observations of Auerbach [10] and
Meshi [11] also suggest that chronic cigarette
smoking leads to pulmonary emphysema. The
males are more prone to suffer from chronic
obstructive pulmonary diseases including
emphysema than the females. [12, 13, 14]
Pneumonia, lung cancer, and gastric ulcer are
significant complications of emphysema, and
may contribute to the cause of death.[15] CT
scans can diagnose, quantitate, and locate mild
to moderate emphysema, in humans, in life,
noninvasively.[16] There has been dramatic
resurgence of interest in surgical treatment of
emphysema, particularly by lung volume
reduction procedures.[17]
Conflict of Interest
None Declared
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This article can be cited as:

Aggarwal B, Singla S, Garg M, Gorea RK. Bullous emphysematous lungs- a case report. J Punjab Acad Forensic Med
Toxicol 2012;12(1):48-9.