Abstract Introduction Typical computed tomography (CT) findings in COVID-19 infection include bilateral, peripheral ground-glass opacities, with or without consolidations, often showing lower lobe and posterior predominance and sometimes accompanied by “crazy-paving” pattern. A spectrum of post-COVID pulmonary sequelae has been reported in interstitial lung disease (ILD) literature. However, emphysema-like changes are rarely described and usually occur in the presence of other risk factors for chronic obstructive pulmonary disease. Herein, we describe a case of a young female never-smoker with persistent paraseptal lucencies mimicking emphysema, thought to be related to prior COVID-19 infection or post-viral pneumonia. Description A 20-year-old-female never smoker with moderate persistent asthma, morbid obesity and prior COVID-19 infection was referred to pulmonary clinic for evaluation of abnormal chest CT. She denied secondhand smoking, vaping, or environmental/occupational exposures. There was no personal or family history of emphysema, alpha-1 antitrypsin deficiency, surfactant disorders, or connective tissue disease. She reported a COVID-19 infection three years prior and a subsequent hospitalization one year later for viral pneumonia and asthma exacerbation, transiently requiring oxygen supplementation. During that hospitalization, contrast-enhanced CT chest demonstrated left lower lobe consolidation and paraseptal emphysema. No prior imaging was available. She subsequently returned to baseline with good functional status and well-controlled asthma on twice-daily budesonide-formoterol. Physical examination was unremarkable without signs of autoimmune disease. Pulmonary function testing demonstrated pre-bronchodilator moderate obstruction (FEV1/FVC 72% Z-score -2.20, FEV1 2.25 L Z-score -2.5) with a significant post-bronchodilator response with 25% increase in FEV1 and FEV1/FVC of 87%. Lung volumes and diffusion capacity were normal. Laboratory evaluation showed normal alpha-1-antitrypsin phenotype (M/M), and negative rheumatologic panel. A follow-up high-resolution CT scan demonstrated persistent paraseptal lucencies without progression. The findings were discussed at our ILD multidisciplinary meeting and were favored to represent post-pneumonia paraseptal lucencies mimicking paraseptal emphysema. Discussion Paraseptal emphysema is a subtype of emphysema typically found incidentally on CT, more commonly in men and classically associated with inhalational exposures (tobacco, marijuana), connective tissue disorders, and Marfan syndrome. However, peripheral or paraseptal lucencies may mimic emphysema and may represent localized alveolar or distal airway dilation without true destruction of alveolar walls. In this patient with asthma, the presence of sharply marginated paraseptal lucencies in the absence of COPD risk factors, preserved diffusion capacity and lung volumes points toward post-infectious/inflammatory remodeling. Awareness of this mimic is important to avoid mislabeling, particularly in the growing cohort of patients with prior COVID-19 infection. This abstract is funded by: None
Moreno et al. (Fri,) studied this question.