Alpha 1 antitrypsin deficiency

Case contributed by Dr Andrew Dixon


Worsening shortness of breath.

Patient Data

Age: 35
Gender: Female

PA and lateral chest x-ray in this young patient demonstrates marked hyperinflation of the lungs (note over 11 posterior ribs visible on PA projection, flattened diaphragm, increased retrosternal air space) and hyperlucency of the lungs with distorted parenchymal architecture. 

Annotated image

Annotated images

Both lungs are markedly hyper-inflated with 11 posterior ribs easily visible above the diaphragmatic domes (yellow dotted lines). The diaphragms are depressed and flattened (best seen on lateral projection, with loss of the normal acute angle formed by the costophrenic pleural reflection (dotted blue line).  

The lungs appear very radiolucent with some areas devoid of lung markings ( * ) suggesting bullous formation. 

On lateral projection the retrosternal air space (RS) is markedly widened (aorta outlined in red). 


Diagram of the three types of emphysema. 

Case Discussion

Severe mid and lower zone emphysema (pan-lobular) in a patient with alpha 1 antitrypsin deficiency.  Note the basal predominance which helps differentiate this condition from the far more common centrilobular emphysema of smoking.

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Case information

rID: 9674
Published: 11th May 2010
Last edited: 30th Jan 2019
System: Chest
Inclusion in quiz mode: Included

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