Emphysema and bronchiectasis in a 48-year-old male

Introduction

A 48-yr-old male was admitted to the hospital with a complaint of chronic cough with mucoid expectoration for the past 27 years. His symptoms frequently worsened in the form of fever, increase in the amount of expectoration and foul smell of expectoration. The patient also complained of difficulty in coughing up sputum. Cough had been associated with exertional dyspnoea for the previous 10 yrs. There was no history of haemoptysis, wheezing, allergic reactions, weight loss or chest pain.

The patient had been on bronchodilators and antibiotics intermittently with partial relief in symptoms during this period. There was no significant family history of similar or other illnesses.

On general physical examination, grade-I clubbing was present. On auscultation, the patient had bilateral coarse crepitations over the chest. When the patient was asked to cough, it was weak/ineffective and there was a loud, rasping sound. Routine blood counts, biochemistry and serum α₁-antitrypsin levels (1.58 g·L⁻¹) were within normal limits. Frontal view chest radiograph and high-resolution computed tomography (CT) of the thorax were performed (figs 1 and 2).