Severe bullous disease in alpha-1 antitrypsin deficiency

Large bilateral subpleural bullae lead to retraction of the underlying normal lung parenchyma. The bullae have an increased compliance and allow normal lung to retract according to its intrinsic elastic recoil. The bullae are not under tension; their effect is similar to that of a pneumothorax ("intrapulmonary pneumothorax"). maid of honor wears look unusual