Abstract
We present a case of a 36-year old male who was a long-term smoker and was found to have giant bullous emphysema on chest imaging as an accidental finding. At the time, when his first chest CT was obtained, he was asymptomatic and was recommended to consult a pulmonologist but was lost to follow-up for a year until he presented to the emergency department with fever, dyspnea, and chest pain. He was admitted to a pulmonology department. Chest CT was performed and it revealed infected bullae containing air-fluid levels as a complication of community-acquired pneumonia. After successful antibacterial treatment, the patient was discharged and recommended to consult with a thoracic surgeon. A few months later, he had video-assisted thoracoscopic surgery and left upper lobectomy as part of definitive treatment.