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A 73-year-old male presented to our hospital with a two-week history of bloody sputum. At the age of 66-year-old, the patient was diagnosed as having severe chronic obstructive pulmonary diseases, respiratory function test performed two years before revealed forced expiratory volume in one second 18% predicted. On admission the patient was cachectic. The temperature was 37°C; pulse, 92 beats per minute; respirations, 18 breaths per minute; and BP 136/82 mmHg. Breath sounds were diminished over the both anterior and lateral areas of the chest. With the patient breathing 2 L of oxygen by nasal cannula, the saturation level was 95%. The WBC count was 6600 cells/mL with 59% neutrophils, 28% lymphocytes, 2% band cells, and 10% mononuclear cells. Serum C-reactive protein (CRP) level was 1.26 mg/dL. The hemoglobin value was 11.2 g/L, and the platelet count was 251.000 cells/mL. The BUN level was 17 mg/dL, and the creatinine value was 0.77 mg/dL, respectively. Electrolyte levels, liver tests, and coagulation studies were within normal limits. Serum aspergillus antigen was positive. The admission chest computed tomography (CT) scan demonstrated an air-fluid level within emphysematous bulla in the right lower lobe (Figure 1), which was not found in the emphysematous bulla in chest CT scan taken one year previously. Sputum cultures yielded no pathogenic microorganism. Bronchoscopy and percutaneous needle aspiration were not performed as the respiratory state and general condition of the patient was very poor. Despite the presence of blood sputum and deterioration of respiratory condition, there was Dr. Hiroaki SATOH Department of Respiratory Medicine, Mito Medical Center, Tsukuba University, Miya-machi 3-2-7, MITO JAPAN e-mail: hirosato@tsukuba.ac.jp Yazışma Adresi (Address for Correspondence) Cite this article as: Osawa H, Okauchi S, Satoh H. Air-fluid level in emphysematous bullae. Tuberk Toraks 2019;67(3):234-5.