Combined pulmonary fibrosis and emphysema

Case contributed by Amr Farouk
Diagnosis almost certain

Presentation

Long history of dyspnea, cough, and expectoration. The patient is a heavy smoker for 40 years.

Patient Data

Age: 70 years
Gender: Male

Bilateral panlobular and paraseptal emphysematous changes with subpleural blebs

Associated left upper lobe partial collapse is also noted. Multiple pathologically enlarged bilateral hilar and mediastinal lymph nodes are seen at pre-vascular, retrocaval, aorto-pulmonary window and subcarinal locations. Right upper lobe posterior segment calcified pulmonary nodule and retrocaval calcified lymph node are seen indicative of an old granulomatous infection.

Case Discussion

Coexistence of usual interstitial pneumonia (UIP) with emphysema in a chronic smoker suggestive of combined pulmonary fibrosis and emphysema.

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