Two cases where bedside ultrasound was able to distinguish pulmonary bleb from pneumothorax

Distinguishing large pulmonary bullae from an acute pneumothorax can present a diagnostic challenge in the emergency setting. Plain film radiography of the chest may be inadequate to make the diagnosis. As the management of these two entities varies significantly, a clinical adjunct to aid diagnosis would prove useful. Using emergency department bedside ultrasound, we identified the typical 'comet tailing' phenomenon of the movement of the lung tissue against the pleura during respiration, present in bullous disease but absent if the lung has collapsed. We present two patients, one with bullous emphysema and another with pneumothorax, in whom bedside ultrasound aided in making the diagnosis.