Chronic Obstructive Pulmonary Disease With Emphysema and Giant Bullae in a Smoker

Abstract

Radiation diagnosis in evaluating chronic obstructive pulmonary disease (COPD) is used to distinguish clinically similar diseases and to identify concomitant pathological changes. Highresolution computed tomography (HRCT) is employed for detailed analysis of the status of the lung. HRCT can visualize primarily centrilobular, panlobular, paraseptal, and bullous emphysema and bronchiectases, is of great importance in the anatomical characteristics of the disease and in the identification of the phenotype of COPD.The paper describes a clinical case of COPD with bullous emphysema in a 60-year-old man. The CT pattern presents with lower-density bilateral multiple centrilobular avascular areas without clear boundaries, as well as by paraseptal emphysema areas, also localized mainly in the lower segments of both lungs, with thin-walled air cavities occupying up to one third of the hemithorax on both sides. CT made it possible to visualize upperlobular centrolobular emphysema, pulmonary bullae, to estimate their sizes, and to identify compression atelectasis in the adjacent lung areas. The differential diagnosis included bronchiectasis disease, histiocytosis X, and lung carcinoma.This clinical case demonstrates that HRCT is the method of choice for differential diagnosis, a follow-up, and assessment of the results of treatment for COPD with a preponderance of bullous emphysema, including in the presence of a doubtful radiographic pattern.