CTICasesSevere Basal-Predominant Emphysema of Uncertain Etiology in a Young Patient
Imaging findings
In a young patient, chest CT shows extensive areas of lung transradiancy with variably distributed internal architecture, most severe in the left lower lobe and also involving the right lower lobe, with a striking lower-zone (basal) predominance. Small-caliber pulmonary vessels can still be identified coursing through the abnormal lung, and the patient does not have honeycombing or fibrosis. Alpha-1 antitrypsin testing was negative.
Key takeaways
Basal-predominant, vessel-preserving destructive lung disease in a young patient without alpha-1 antitrypsin deficiency raises concern for an inhalational or injection drug exposure -- such as IV-crushed-tablet (excipient) lung disease from stimulant misuse -- given the strikingly lower-zone, vascular-territory distribution rather than the more airway-centered or apical pattern of typical emphysema; the preserved, coursing vessels within the abnormal lung help distinguish this destructive process from true cystic lung diseases such as LAM, which classically preserve normal vessel caliber.
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