C46-17 A Unique Case of Pure Para-septal Emphysema in a Young Adult

Para-septal emphysema (PSE) often presents superimposed with other forms of emphysema such as centrilobular emphysema. Pure PSE, however, is a rare subtype that only affects the distal acini adjacent to the visceral pleura. Though quite rare, when pure PSE does present, it typically affects the elderly who have a long history of smoking, is significantly more common in males, and almost always affects the upper lobes of the lungs. The mean age of diagnosis of pure PSE in one of the reported studies was 63.9 years with a mean smoking history of 36 pack-years. It is also associated with relatively lower FEV1/FVC ratio and a reduced diffusion lung capacity of carbon monoxide on pulmonary function testing. Our patient’s presentation was quite unique; a healthy young, 26-year-old female who presented with atypical symptoms of heartburn, chest pain, and episodic shortness of breath associated with talking and eating, but unassociated with exertion who has no active or prior smoking history. She did report exposure to second-hand smoking in her household. She was found to have pure PSE affecting not only the upper lobes, but also the lower lobes of the lungs on chest CT scan, with completely normal pulmonary function tests. As this patient had no prior history of smoking or other risk factors for developing pure PSE at such a young age, and with no prior studies linking second-hand smoking to pure PSE, this case serves to showcase how pure PSE can have a varying presentation and the possibility of a higher incidence in younger individuals than once thought. It also opens up a discussion for second hand smoking possibly being a risk factor for development of pure PSE, which has not been reported previously. As the world advances towards highly sensitive non-invasive imaging modalities, the incidental finding of pure PSE will keep growing necessitating the need to further study pure PSE to assess its varying presentation, severity, and prognosis and develop guidelines that provide evidence-based management.