Treatment for a giant lung bulla

This is a 22 year old female with no prior respiratory complaints.  She devloped a bronchitis in February and May, 2008 and had a CXR that suggested bullous disease in the RUL.  PFT’s showed normal spirometry and the diffusion capacity was 89% predicted.  She had no respiratory illness as an infant.

Her CT scan showed the following

Which of the following would you recommend?

1) Leave the bulla alone, no Rx recommended, inform to go to ED with SOB or pain

2) Recommend Scuba diving lessons to utilize hyperbaric conditions to shrink the bulla

3) Refer for an experimental endobronchial valve to deflate the bulla

4) Refer to thoracic surgery for surgical bullectomy

5) Insert a Heimlich valve to permit deflation of the bulla through chest wall

I include a reference regarding 1 way valves:valve

SOB and increasing infiltrates in a 49 year old

This 49 year old male had been healthy but presented with increasing SOB. Below are the radiographs in the first 6 days in the hospital

A CT was done.  Two representative images are below

The CT shows a sinus of valsalva aneurysm that is nearly completing obliterating the LA cavity approximately 4 cm, causing a pulmonary venous obstruction. See the enclosed echo report from SMH and a brief reference.  echo-report-s-of-v  s-of-v-cardiolgy

While I could find reports of S of V aneurysm causing Ra-RV inflow obstruction, I could not find a similar case of a LA obstruction as in this presentation.  There are 3 sinuses of Valsalva, so it likely is that one is more susceptible to aneurysm formation but that is my own speculation. 

34 year old female with SOB and abnormal CT

This 34 year old female presented for evaluation with 2 months of increasing shortness of breath, chest tightness and cough.  There was minimal sputum production, but she is uncomfortable at night and had to sleep with 2 pillows.  Wheezing had been present but she did not respond to steroids, albuterol or Symbicort. Her lab data was normal except for a positive mono test.  She was not exposed to any aerosols.  She is a non-smoking, non-drug using female with 2 children living in a rural enviroment.

The CT images are shown:

What are possible diagnoses and how would proceed at this time