Surgical pathology of bullae with and without pneumothorax

Experience with 2030 patients admitted for an actual episode ofspontaneous pneumothorax, and with 370 patients hospitalized for bullousemphysema is thoroughly analyzed. Out of these groups, 400 patients (318and 82 respectively) underwent an open thoracotomy. Macroscopic operativefindings were divided into 8 groups. Descriptions of the aspect, size andsite of bullae, respiratory function, mortality and follow-up data, arepresented. Pathogenesis of the localised apical disease in comparison tothe extended and diffuse types is outlined. Attention is drawn to the highoperative risk in generalized emphysema and airway obstruction whenassociated with tension bullae and/or pneumothorax. More than 30% of thepatients could not be included in either the juvenile type, isolated apicaldisease, or in the category of bullae associated with generalizedemphysema. Reasons for an early rupture of apical subpleural blebs and thehigh resistance to check valve pressure of bullae following alveolardisruption are discussed. The observations lead to the conclusion thatsurgical pathology and treatment problems in bullous emphysema and inspontaneous pneumothorax have a lot in common and their arbitraryseparation is not justified.