54 year-old man was referred to pulmonary clinic for progressive dyspnea and right sided chest pain. The patient's physical activity was severely reduced due to dyspnea. He was found to have right-sided giant bulla. A Computed tomography (CT) of chest showed a giant bulla involving the right upper and middle lobes .
Physical examination revealed no cervical, supraclavicular, and axillary palpable lymph nodes. Chest exam was significant for absence of breaths sounds over right hemithorax. Left lung, cardiac, and abdominal exam was unremarkable. Pulmonary function test revealed decreased forced expiratory volume in first second (FEV1) and increased residual volume (RV). Arterial blood gas showed PH of 7.41, partial pressure of Co2 (PCO2) of 43 mmHg, and partial pressure of oxygen (PO2) of 69 mmHg.
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