Abstract
A 55-year-old male, with past history of COPD, presented with progressive shortness of breath of five days duration, associated with cough and increased sputum production. He had a 30 pack year smoking history and worked as a clerk in a plumbing store for two decades. On examination, he was afebrile, breathing at 20 /min with Oxygen saturation of 91% on 2 liters of oxygen. He was also tachycardic at 104 /min. Chest exam revealed fair air entry bilaterally with diffuse wheezing and a prolonged expiratory phase. Initial laboratory workup was within normal limits. His chest X-ray showed bilateral extensive opacity in the mid-lower zones, and hyperinflation. An axial CT scan was done (Figure 1).
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