75 year old male with 20 pack year history of smoking. No reported history of occupational exposure.
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HRCT and coronal reformat (lung window) shows bilateral lower-lobe panlobular emphysema consistent with known history of
Although this case demonstrate the familiar imaging appearance of alpha1-antitrypsin deficiency, the disease can have a range of imaging manifestations including upper-lobe-predominant emphysema and emphysema with cystic bronchiectasis.1,2 Disease severity is multi-factorial influenced by genotype/phenotype, serum level of alpha1-antitrypsin and compounded by smoking/ocupational exposure .1,2