Higher altitude, bigger bulla

A 28-year-old woman presented to the emergency centre of First People’s Hospital of Yunnan Province with a 10-day history of dyspnoea and chest tightness. She had no history of cigarette smoking or drug use and no personal or family history of respiratory diseases. She used to live in Hefei, Anhui Province (with an average altitude of 20 metres). Ten days prior to presentation, she had moved to Kunming, Yunnan Province (a higher altitude area with an average altitude of 1900 metres) to take up a new job. She was in mild distress with an oxygen saturation of 95% while breathing ambient air. The physical examination revealed hyper-resonance and decreased breath sounds in the right hemithorax. The chest X-ray demonstrated a large lucency occupying the entire right hemithorax, with contralateral mediastinal shift (figure 1A). Subsequently, CT of chest revealed no sign of compressed lung tissue on the right (figure 1B …