Presentation
Active smoker with 200 pack year history. Severe COPD on home oxygen. Presents with 2 weeks increased dyspnea, increased sputum production, cough.
Patient Data
Portable AP study. Hyperinflated lungs with diffuse reticular changes. Noted large (25 cm) right lung bulla. No infiltrate noted. No pneumothorax. No effusion noted, though costodiaphragmatic angle not fully visualized. Aortic knob shows calcifications.
Compared to previous imaging (not shown), this bulla has been stable since 2010.
Case Discussion
This patient was admitted to the ICU for management of COPD exacerbation. Treated with steroids, antibiotics, and nebulizer treatments. He was subsequently discharged after about a week. His stay was largely uncomplicated despite the impressive chest x-ray on admission.
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