Combined pulmonary fibrosis emphysema syndrome complicated by pneumomediastinum and subcutaneous emphysema

Case contributed by Dr Salman S. Albakheet


Heavy smoker, presented with progressive dyspnea.

Patient Data

Age: 65 years
Gender: Male

There is bilateral diffuse reticular interstitial lung thickening with subcutaneous emphysema in the neck. Normal cardiac shadow. Streak of air lucency noted at the upper mediastinum with sharp demarcation of cardiac border indicating pneumomediastinum. Blunted left costophrenic angle. 

There is extensive subcutaneous surgical emphysema dissecting along the fascial planes of the lower neck and extend right anterior and posterior chest wall. Significant pneumomediastinum is seen. There are bilateral diffuse predominantly upper lobes interstitial lung thickening with subpleural honeycombing are seen. Bilateral diffuse centrilobular cylindrical traction bronchiectatic changes. Bilateral predominantly upper centrilobular and paraseptal emphysematous changes. A calcified left hilar lymph node is noted.

Case Discussion

In smokers, the combination of emphysema and fibrosis is becoming more and more recognized. Patients are almost exclusively men in their 6th and 7th decades. Lung volumes are relatively preserved. Honeycombing, reticular opacities, paraseptal and centrilobular emphysema, and traction bronchiectasis are the most frequent findings at high-resolution CT.

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