Correct!
1. The opacity was an intra-bulla hemorrhage related to treatment with warfarin.
Intra-bulla hemorrhage is a rare complication in bullous emphysema which usually occurs in patients on anticoagulant therapy (4). It may occur when a bulla enlarges leading to rupture of intrabulla vessels. The presence of a large blood clot in the bulla can have very similar radiologic features to a mycetoma (4-6). The resolution of the mass was thought to be too rapid and not consistent with a mycetoma. There was no evidence of foreign body or aspiration on bronchoscopy. The reasons for the resolution of the bulla are not certain, but blood can cause a fibrotic response in the lungs which may have contributed to the resolution of the bulla.
References
- The Lancet Respiratory Medicine. The death of low-dose oral theophylline for COPD? Lancet Respir Med. 2018 Jul;6(7):479. [CrossRef] [PubMed]
- Robbins RA. COPD exacerbations: an evidence-based review. Southwest J Pulm Crit Care 2012;5:36-51. [CrossRef]
- Walker CM, Abbott GF, Greene RE, Shepard JA, Vummidi D, Digumarthy SR. Imaging pulmonary infection: classic signs and patterns. AJR Am J Roentgenol. 2014 Mar;202(3):479-92. [CrossRef] [PubMed]
- Nagashima O, Suzuki Y, Iwase A, Takahashi K. Acute hemorrhage in a giant bulla. Intern Med. 2012;51(18):2673. [CrossRef] [PubMed]
- Withey S, Tamimi A. Spontaneous pulmonary haemorrhage into an existing emphysematous bulla. BMJ Case Rep. 2016 Jan 7;2016:bcr2015213144. [CrossRef] [PubMed]
- Lobo-Rebollo MJ, García-Barón C, Villar-Álvarez F. Acute Hemorrhage into an Emphysematous Bulla. Arch Bronconeumol. 2023 Jun;59(6):394-395. English, Spanish. [CrossRef] [PubMed]
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