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Chest clinic
Rare cause of emphysema
  1. Tobias Matthieu Benoit1,
  2. Rahel Schwotzer1,
  3. Didier Schneiter2,
  4. Jan Hendrik Rüschoff3,
  5. Daniel Peter Franzen4
  1. 1Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland
  2. 2Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
  3. 3Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
  4. 4Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Tobias Matthieu Benoit, Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, 8091, Switzerland; tobias.benoit{at}usz.ch

http://dx.doi.org/10.1136/thoraxjnl-2020-215561

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    Case presentation

    A 52-year-old man with chronic obstructive pulmonary disease GOLD 4, group D, and severe, heterogeneous pulmonary emphysema (figure 1) and marked hyperinflation was treated with bronchoscopic lung volume reduction (LVR) using endobronchial valves (EBVs) and, 6 months thereafter, bilateral thoracoscopic lung volume reduction surgery (LVRS), both after multidisciplinary team consensus. The interventions individually resulted in a clear but only short-term success due to rapid progression of emphysema and hyperinflation. After EBV treatment, forced expiratory volume in one second (FEV1) improved from 0.86 L (23% predicted) to 1.16 L (31% predicted), and residual volume (RV) improved from 5.14 L (219% predicted) to 4.93 L (210%). Only 4 months thereafter, FEV1 dropped to 0.68 L (18%), while RV increased to 5.84 L (266% predicted). At 3 months after LVRS, FEV1 increased again to 0.87 L (23% predicted), and RV decreased to 5.40 L (227% predicted). However, chest CT revealed progressive emphysematous changes, and the patient experienced increasing dyspnoea again. Negligible …

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    Footnotes

    • Contributors TMB, RS, DS, JHR and DF wrote the paper. TMB contributed figure 1. JHR contributed figure 2.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request.