Increasing shortness of breath.
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The mid and upper zones of both lungs are markedly hyperlucent, with splayed pulmonary vasculature suggesting bullae. The lower zones demonstrate crowding of the pulmonary / vascular markings. A right sided pleural effusion has developed with dependent patchy atelectasis. The heart is at the upper limit of normal.
This patient has extravagant apical bullous emphysema.