Characteristic radiographic features of pulmonary carcinoma associated with large bulla.

Primary lung cancer closely associated with a large bulla was investigated in an attempt to elucidate radiographic features of the tumor. On the basis of findings in 7 of our patients plus data on another 25 patients in the Japanese literature, we propose three major patterns of neoplasm development: nodular opacity within or adjacent to the bulla, partial or diffuse thickening of the bulla wall, and secondary signs of the bulla (changed diameter, fluid retention, and pneumothorax). As the incidence of occurrence of a pulmonary carcinoma in association with bullous disease is high, these radiographic findings will aid in early detection of a malignant lesion.