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Postgraduate Education Corner: CHEST IMAGING AND PATHOLOGY FOR CLINICIANS |

A Young Patient With a Minimal Smoking History Presents With Bullous Emphysema and Recurrent Pneumothorax*

Eduardo Mireles-Cabodevila, MD; Hina Sahi, MD; Carol Farver, MD; Tan-Lucien Mohammed, MD; Daniel A. Culver, DO, FCCP
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*From the Departments of Pulmonary, Allergy and Critical Care Medicine (Drs. Mireles-Cabodevila, Sahi, and Culver), Diagnostic Radiology (Dr. Mohammed), and Anatomic Pathology (Dr. Farver), Cleveland Clinic, Cleveland, OH.

Correspondence to: Daniel A. Culver, DO, FCCP, Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: culverd@ccf.org



Chest. 2007;132(1):338-343. doi:10.1378/chest.06-2987
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Acute-onset dyspnea and substernal chest pain radiating to the back developed in a 46-year-old African-American woman while she was watching television. There was no cough, fever, or chills. She had been admitted to the hospital 3 months earlier with a similar presentation; a spontaneous, left basal pneumothorax was found and was treated with tube thoracostomy.

Six years before that, she had been first told she had emphysema and was treated with inhaled bronchodilators; she stopped smoking (smoking history, 13 pack-years). A review of prior chest radiographs demonstrated that emphysema involving predominantly the upper lobes had been present 13 years prior (smoking history at that time, 5 pack-years). Her medical history was remarkable for two episodes of suspected pneumonia in her early thirties, hypertension, hyperlipidemia, and diffuse idiopathic skeletal hyperostosis. She worked as a data processor in a health institution; had never been exposed to fumes, dusts, asbestos, or silica; denied any drug use; and had no family history of lung disease. A careful review of systems revealed occasional arthralgias, mainly involving the hips, elbows, and the thoracic spine. There was no history of urticaria, ocular disease, or joint laxity.

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