PURPOSE: we reviewed the imaging findings in 7 patients with idiopathic giant 
bullous emphysema. This is a chronic, progressive condition usually affecting 
young male smokers and is characterized by giant emphysematous bullae, which 
commonly develop in the upper lobes. Extensive paraseptal emphysema coalesces to 
form giant bullae, compressing the normal lung parenchyma and often displacing 
it centrally. These bullae occupy at least one-third of a hemithorax.
MATERIALS AND METHODS: Seven patients with chest radiographic evidence of a 
bulla or bullae occupying at least one-third of a hemithorax, who had also been 
examined with high-resolution computed tomography (HRCT), were included in this 
retrospective study. On HRCT scans, the size, location, and distribution of the 
bullae were documented and categorized as either subpleural or central.
RESULTS: The HRCT scan findings in all 7 study patients included numerous bullae 
ranging in size from a few centimeters in diameter to giant bullae nearly 
filling an entire hemithorax, mimicking a pneumothorax. Five of the 7 patients 
had extensive upper lobe predominant bullae, 4 of the 7 patients showed severe 
bilateral disease with asymmetric involvement, 2 of the 7 patients demonstrated 
left lung predominance and whereas 1 patient showed right lung predominant 
disease. All of our patients had subpleural bullae, had parenchymal fibrosis, 
another had extensive subcutaneous emphysema, and 1 had accompanying 
bronchiectasis.
CONCLUSIONS: The predominant findings on HRCT scans are extensive paraseptal 
emphysema coalescing into giant bullae. HRCT is helpful in confirming the 
diagnosis of VLS, assessing the degree of the disease, and providing information 
to guide treatment.