Emphysema Case Study

A 56 year old obese African American female with a history of hypertension, hyperlipidemia, and hypothyroidism presented at out pulmonary department for the management of multiple recurrent episodes of bronchitis and pneumonia over the preceding two years. She denied ever smoking in the past. Chest roentgenogram was significant for multiple right upper and middle lobe, as well as left lower lobe bullae; which was markedly visible on the CT scan of the chest. Serum alfa-1-antitrypsin was negative. She revealed that she was delivered prematurely at the age of six months needed ventilator support for the first four months of life. Her PFTs upon initial presentation revealed increased residual volume and total lung capacity with FEV1/FVC ratio of 70. She underwent bullectomy of the right middle and left lower lobe, along with parietal pleurectomy; and her symptoms had significantly improved. Her PFTs a month after the surgery revealed an FEV1/FVC ratio of 80. Her oxygen saturation was 98% on room air, without the need for supplemental oxygen. She does however, suffer from post-thoracotomy pain syndrome that is controlled on gabapentin usage.
This malformation of the lung is of unknown etiology, and multiple lobar involvement is extremely rare. Symptoms appear during the early neonatal period or during early childhood in majority of the cases, and manifests very uncommonly during adulthood. It is seen very rarely in adults who did not experience any symptoms during childhood. Respiratory distress frequently appearing with a superimposed lower respiratory tract infection is very typical. Surgical management (via thoracotomy or thoracoscopic approach) has a good prognosis in