CTICasesAlpha-1 Antitrypsin Deficiency treated with Endobronchial Valve Lung Volume Reduction
Imaging findings
Sequential chest radiographs in a patient with alpha-1 antitrypsin deficiency and severe basal-predominant emphysema demonstrate bilateral Zephyr endobronchial valves placed in the lower lobe bronchi. Radiographic follow-up shows progressive contralateral shift of the anterior junction line even before visible opacification, followed by development of left lower lobe collapse with inferior displacement of the valves, indicating successful endobronchial lung volume reduction.
Key takeaways
Endobronchial valve lung volume reduction (LVRS) works by one-way valve blockade of segmental bronchi, allowing air to exit but not enter, resulting in progressive lobar collapse. On chest radiography, early shift of the anterior junction line (mediastinal shift) is the first radiographic sign of volume loss in the treated lobe, preceding visible lobar opacification. This sign is useful for early assessment of procedural success.
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