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November 1, 1976

Extensive Bullous Emphysema in a Young Woman

Author Affiliations

From the University of Wisconsin Center for Health Sciences. Dr Rankin is now with the Department of Radiology, University of Utah Medical Center, Salt Lake City.

JAMA. 1976;236(18):2107-2108. doi:10.1001/jama.1976.03270190061039

History  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).

Diagnosis  Antitrypsin, deficiency.

Comment  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