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Are hyperinflated lungs always indicative of COPD or lung pathology?
This in regard to a patient w/ possible chronic "hyperventilation syndrome", which is associated with anxiety and psychogenic dypnea and a 'tendency to breathe by using the upper thorax rather than the diagphram, resulting in chronically overinflated lungs'. Patient is an ex-smoker with a 6 pack year history and good exercise tolerance.
CXR shows bilateral hyperinflated lung fields. Pulmonary vasculature within normal limits. No other pathology.
CXR was taken during a panic episode in---heavy breathing, tachycardia, etc---in order to rule out aortic dissection. EKG revealed right bundle branch block--likely due to the hyperinflation. After settling down the patient was discharged with no instructions to follow up on CXR findings, but just to followup on anxiety issues with primary care.
Pulse ox is normal.
PFT states: FVC, FEV1, FEV1/FVC ratio and FEF25%-75% are within normal limits (FEV1/FVC=86%). The airway resistance is normal. The TLC, FRC and RV are increased indicating overinflation. The diffusing capacity is normal. However, the diffusing capacity was not corrected for the patient's hemoglobin. CONCLUSION: Overinflation without concurrent obstruction is of uncertain significance.
Is this emphysema, or could it be benign? Can anyone suggest further workup? Thank you.
This in regard to a patient w/ possible chronic "hyperventilation syndrome", which is associated with anxiety and psychogenic dypnea and a 'tendency to breathe by using the upper thorax rather than the diagphram, resulting in chronically overinflated lungs'. Patient is an ex-smoker with a 6 pack year history and good exercise tolerance.
CXR shows bilateral hyperinflated lung fields. Pulmonary vasculature within normal limits. No other pathology.
CXR was taken during a panic episode in---heavy breathing, tachycardia, etc---in order to rule out aortic dissection. EKG revealed right bundle branch block--likely due to the hyperinflation. After settling down the patient was discharged with no instructions to follow up on CXR findings, but just to followup on anxiety issues with primary care.
Pulse ox is normal.
PFT states: FVC, FEV1, FEV1/FVC ratio and FEF25%-75% are within normal limits (FEV1/FVC=86%). The airway resistance is normal. The TLC, FRC and RV are increased indicating overinflation. The diffusing capacity is normal. However, the diffusing capacity was not corrected for the patient's hemoglobin. CONCLUSION: Overinflation without concurrent obstruction is of uncertain significance.
Is this emphysema, or could it be benign? Can anyone suggest further workup? Thank you.