White lung: chronic obstructive pulmonary disease
What is the cause of this patient’s shortness of breath?
A 77 year old man presented to an emergency department with a three day history of worsening breathlessness. He denied a productive cough and was unaware of any recent weight loss. He was a retired navy worker with a smoking history of 12.5 pack years. He had hypertension and chronic constructive pulmonary disease. He had a medical history of tuberculosis.
On examination he was apyrexial and normotensive, with a respiratory rate of 30 breaths/min. He could complete sentences fully. His initial oxygen saturations on room air were 95%. A left posterior thoracotomy scar was noted on inspection of his chest. His trachea was centrally positioned. He had an absence of breath sounds and a dull percussion note over the entire left hemithorax and a scattered wheeze throughout the right lung. Nebuliser therapy was started, and his condition improved. A chest radiograph was taken (figure).
(1) Describe the abnormalities in the