A patient with severe emphysema and aspiration pneumonia.

A 68-year-old male patient has history of severe emphysema and esophageal achalasia. He was admitted to the intensive care unit with acute on top of chronic hypercanic respiratory failure and right lower lobe pneumonia. The patient improved after treatment for aspiration pneumonia with antibiotics and supportive measures. Figure 1 is an anteroposterior (AP) view of the chest showing bilateral bullous changes and right lower lobe infiltrate. Figure 2A and B is a chest computed tomography (CT) scan images showing severe bilateral bullous lung disease and dilated esophagus with retained fluid material (arrow). Figure 3 is a chest CT scan image with oral contrast showing severely dilated esophagus consistent with achalasia. Photographs and text from: Matthew T. Dudley, Wayne State University School of Medicine, Detroit, MI; Ayman O. Soubani, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA. email: [email protected]