Presentation
Known emphysema. Severe SOB.
Patient Data
Severe bilateral emphysema with large volume bullous disease in the right upper and left lower lobes.
Segmental collapse of the right middle lobe.
Heart size normal.
The right upper lobe is replaced by a single large bulla.
Extensive bullous disease in the left lower lobe.
Segmental collapse in the right middle lobe.
Normal mediastinum.
Small hiatus hernia.
No PE.
Extension perfusion deficits due to the bullous disease illustrated on the CT scan, best illustrated in the right upper lobe.
Case Discussion
This case illustrates a case of severe bullous emphysema.
The greatest merit of the case is in illustrating the impact that bullous emphysema or other structural lung disease has on VQ scan appearances and one's ability to interpret if a pulmonary embolism is present.