Hyperinflated lungs

[jakesaw]

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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.

 

[jakesaw]

Correction/Addition: EKG reveals mild right axis deviation likely due to hyperinflation (also incomplete RBBB as incidental finding). PE was ruled out.

 

[f_w]

If I remember correctly, the PFTs are fairly normal in patients with alpha-1-antitrypsine deficiency. That and a fairly short smoking history can give you pretty wrecked lungs, otoh most of these guys don't have much of an exercise tolerance left when they present.

 

[jakesaw]

Thanks. I'm sure that will be worked up.

 

[doepug]

Hyperinflation does not always reflect pathology. Healthy patients who listen to the tech and take a deep breath will appear hyperinflated. There are secondary signs on a chest film (e.g. airway wall thickening, flattened diaphragms) that are more suggestive of emphysema. By itself, hyperinflation is not diagnostic.

 

[jakesaw]

Hyperinflation does not always reflect pathology. Healthy patients who listen to the tech and take a deep breath will appear hyperinflated. There are secondary signs on a chest film (e.g. airway wall thickening, flattened diaphragms) that are more suggestive of emphysema. By itself, hyperinflation is not diagnostic.

Thanks. The CXR was taken at maximal inspiration as you mentioned. Aside from the hyperinflation, no other signs were mentioned on the report. Do you think an HRCT would give better diagnostic info?

PFT tests also support overinflation, yet without concurrent obstruction. FEV1/FVC, pulse ox, diffusion capacity all normal.

 

[applemas]

If we review only barrel shaped chest, hyperresonant percussion sound, CXR: hyperinflated lung. Patient is ex-smoker. Do we need to give any recommenations/ treatment to patient?

 

[Big Ben]

You don't get COPD with 6 pack years of history without a1 antitrypsin deficiency. COPD is defined by PFTs...a normal FEV1 means he/she is not obstructed....stop irradiating