Emphysema and bronchiectasis secondary to alpha-1 antitrypsin deficiency.

A 47-year-old Caucasian male presented to the chest clinic with a 4-week history of exertional dyspnea. A chest radiograph showed mild hyperinflation without any focal pathology and spirometry showed a mild obstructive defect. In view of symptoms being disproportionate to spirometric and radiologic abnormalities, a thoracic CT scan was obtained. It revealed that there was evidence of bronchiectasis and mild emphysema in basal distribution. Subsequently, he was confirmed to have severe α1-Antitrypsin deficiency. This case illustrates the importance of considering α1-Antitrypsin deficiency in patients with combination of emphysema and bronchiectasis in a basal distribution. Although basal emphysema is well-recognized pulmonary manifestation of α1-Antitrypsin deficiency, it is extremely unusual to have bronchiectasis with very mild degree of emphysema.