This young patient has emphysema as a result of alpha-1-antitrypsin deficiency. Hyperinflation is noted as a generalized increase in radiolucency due to increased aeration and spread of vasculature, an increased AP chest diameter and retrosternal airspace on the lateral view, and diaphragmatic domes projecting well below the normal level of the 10th rib posteriorly and the 6th rib anteriorly on the PA view.