A 24-year-old woman had shortness of breath of several months' duration and complained of a "cold that lasted all winter," associated with cough. She had smoked one pack of cigarettes per day for five years. Physical examination showed that she breathed through pursed lips and had distant heart sounds. Pulmonary function tests were consistent with severe obstructive airways disease. An aunt and uncle of the patient also complained of chronic dyspnea.The correct diagnosis was suggested by the roentgenologist from the routine chest films (Fig 1 and 2).
The chest films show striking pulmonary emphysema with preferential involvement of the lower lobes (Fig 1). Bullae are evident in the anterior clear space on the lateral view (Fig 2). A pulmonary angiogram (Fig 3) demonstrates a dramatic asymmetry of perfusion between the upper and lower lung fields and verifies the severity of involvement in this young
Rankin RS. Extensive Bullous Emphysema in a Young Woman. JAMA. 1976;236(18):2107–2108. doi:10.1001/jama.1976.03270190061039