Combined pulmonary fibrosis and emphysema with lung cancer: Triple calamity

Sir, Combined pulmonary fibrosis and emphysema (CPFE) has been increasingly understood to be a distinct entity characterized by the presence of histological or radiological evidence of lower lobe fibrosis and upper lobe emphysema, commonly seen in males and smokers, with reasonably preserved lung volumes and disproportional impairment in gas exchange. Blood investigations revealed a total serum protein and albumin of 8.3 and 3.7 g per deciliter (g/dL), respectively (normal range of 6.6–8.3 and 3.5–5.2 g/dL, respectively), with normal complete blood counts, coagulation profile, and renal and liver function tests. [1],[4] Lower lobe preference is attributed to the causal role of fibrosis to carcinogenesis and explains why a similar radiological presentation is seen in patients with lung cancer and lung fibrosis alone without emphysema.