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Combined pulmonary fibrosis and emphysema

Case contributed by Rachael O'Rourke
Diagnosis certain

Presentation

Current smoker with a roughly 15-20 pack year history of smoking (half a packet per day since the age of 35). Imaging of chest performed for incidental reasons, no respiratory symptoms of note and has not noted any breathlessness or limitation of her activities. No symptoms or signs of arthritis and no features of connective tissue disease. Complex lung function testing revealed normal volumes and spirometry with severely reduced gas transfer (KCO 42% predicted).

Patient Data

Age: 70 years
Gender: Female

Upper lobe lucency with lower lobe reticular opacification. These findings are subtle and difficult to identify confidently without the benefit of a CT.

Axial and coronal non contrast CT shows upper lobe predominant emphysema, with changes indicating fibrosis towards the lung bases such as septal thickening, regions of honeycombing, architectural distortion and volume loss.  

Case Discussion

70 year old female patient with a 16-20 pack year history of smoking. Diagnosed clinically and via imaging (three years prior) with combined emphysema and pulmonary fibrosis, with normal dynamic lung volumes, but severely reduced gas transfer (KCO 42% predicted).

CT findings are typical, showing upper lobe emphysema progressing to fibrosis with honeycombing in the lung bases. 

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