RESUMEN
Infected bullae are frequently confused with a pulmonary abscess. There recognition is important to avoid unnecessary interventions. We describe a case of 70 years male patient, who came with complaints of breathlessness since 5 years, cough with a moderate amount of mucopurulent expectoration, pain in back and right shoulder and low-grade intermittent fever all since 20 days. Past history was unremarkable. There is a history of 100 pack-years. On examination, he was tachypneic, having oxygen saturation of 87% on room air. On respiratory examination; the finding was consistent with emphysema with right sided cavitary disease. Chest X-ray showed thin walled cavity with fluid level in the right upper zone with pneumothorax on the left side. Investigations revealed 17, 000 white blood cell with neutrophil predominance. He was not responding adequately so high-resolution computed tomography (HRCT) was ordered which showed multiple thin-walled bullae in both lung along with air-fluid level in one large bullae with surrounding pneumonitis on the right side. Infected emphysematous bullae should be suspected when a fluid level appears in a patient with clinical finding suggestive of emphysema. We propose that symptomatic patients with radiological signs of air-fluid level should be evaluated with HRCT to rule out similar condition and assessment of underlying condition.