Fig. 4

A 46-year-old smoker presenting to the emergency department (ED) with chest pain. Frontal chest radiograph (a) demonstrates hyperlucency through the right chest (thin arrows) with few dependent fluid levels; this was interpreted as a hydro pneumothorax. Post chest tube placement, both axial (b) and sagittal (c) CT images demonstrate chest tube within the right minor fissure (solid white arrow), abutting a giant bulla (defined as bulla occupying more than 30 % of the hemithorax). The bulla can be differentiated from a pneumothorax by the presence of septae (arrowhead) and compression of the lung parenchyma, unlike a pneumothorax where a visceral pleural line should be seen. The initial radiographic assessment was therefore inaccurate