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Basilar Predominant Emphysema: Thinking beyond Alpha-1-Antitrypsin Deficiency
Ho-Man Yeung1, Lauren Gaffaney1
1Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Case Reports in Medicine
|December 19, 2022
Summary
Basilar predominant emphysema, an uncommon pattern, is often linked to alpha-1-antitrypsin deficiency. This case highlights smoking-related emphysema as a key cause, showing successful lung volume reduction improves COPD symptoms.
Area of Science:
- Pulmonology
- Radiology
- Thoracic Surgery
Background:
- Basilar predominant emphysema is an uncommon radiographic pattern.
- It is traditionally associated with alpha-1-antitrypsin deficiency (AATD).
- This pattern involves disproportionate emphysematous changes in the lung bases compared to the apices.
Observation:
- A 59-year-old female with a 41 pack-year smoking history and Stage IV COPD presented with recurrent exacerbations.
- She had bibasilar predominant emphysema and required supplemental oxygen.
- Bronchoscopic lung volume reduction was performed.
Findings:
- The patient showed improved functional status post-procedure.
- She remained hospitalization-free at 15-month follow-up.
- The underlying etiology was diagnosed as smoking-related emphysema with atypical bibasilar involvement, challenging the AATD association.
Implications:
- Careful history taking is crucial for diagnosing lower lobe emphysema.
- Basilar predominant emphysema has a broad differential diagnosis beyond AATD.
- This pattern should be considered distinct from apical predominant emphysema.
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