Giant bullae often mimic pneumothorax on radiographic appearance. We present the 
case of a 55-year-old man admitted to a referring hospital with dyspnea, cough, 
and increasing sputum production; he refused thoracotomy for tension 
pneumothorax and presented to our hospital for a second opinion. A computed 
tomography (CT) scan at our hospital revealed a giant bulla, which was managed 
conservatively as an exacerbation of chronic obstructive pulmonary disease. 
Thoracic surgery was consulted but advised against bullectomy. Giant bullae can 
easily be misdiagnosed as a pneumothorax, but the management of the two 
conditions is vastly different. Distinguishing between the two may require CT 
scan. Symptomatic giant bullae are managed surgically. We highlight the 
etiology, presentation, diagnosis, and treatment of bullous lung disease, 
especially in comparison to pneumothorax.