Case 346

Medical history

A 75-year-old male with a 70 pack-year smoking history presented with weakness, appetite loss and productive cough with a clear sputum, with worsening for the past 5 days. Room air SpO2 was 50%, although he denied dyspnea. There was partial improvement of his clinical condition after oxygen therapy. Examination revealed moderate acute distress, diffusely decreased breath sounds, with no crackles or wheezes, and hypophonic heart sounds. Radiologic examination of the thorax was ordered.

Considering the diagnosis of exacerbated chronic obstructive pulmonary disease (COPD) and the imaging findings, what is the most likely cause of this exacerbation and which COPD radiologic pattern is seen?

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