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Persistent diffuse pulmonary interstitial emphysema mimicking pulmonary emphysema

Department of Respiratory Medicine, Faculty of Medical Sciences, University of Fukui Hospital, Fukui, Japan

Correspondence to:
Correspondence to:
Dr Y Demura
23-2 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; demura@fmsrsa.fukui-med.ac.jp

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A 69-year-old male non-smoker with a history of atopic asthma of >30 years had recently been diagnosed with pulmonary emphysema (chronic obstructive pulmonary disease, COPD) because of exertional dyspnoea and chronic airflow limitation without bronchodilator responsiveness. A laboratory examination revealed a high serum IgE level (1219 U/ml) and a normal ₁-antitrypsin level (142 mg/dl), and the flow-volume curve showed severe chronic airflow obstruction (vital capacity (VC) 2.47 litres (72.3% predicted), forced expiratory volume in 1 s (FEV₁) 0.73 litres (27.4% predicted), FEV₁%-Gaensler 30.8%). The chest radiograph showed severe hyperinflation (fig 1A), but carbon monoxide transfer factor was within normal limits (15.43 ml/min/mm Hg 98.9% predicted). A chest CT scan revealed the presence of free air predominantly along the bronchovascular sheaths of both lungs with thickened bronchial walls; pulmonary emphysema, pneumothorax and pneumomediastinum were not observed (fig 2A and B). The previous repeated episodes of asthma could be . . . [Full text of this article]