This 68-year-old white female was afflicted with severe emphysema due to α1alpha 1-antitrypsin deficiency. She had a 10 pack-year history of cigarette smoking but she had quit smoking 30 years ago. She elected to undergo lung volume reduction surgery to reduce complications of her emphysema. Post-operatively, she was ventilator dependent and her liver function declined. Further studies revealed hepatic cirrhosis. Her pulmonary function continued to decline and she died 26 days after her initial surgery.  At autopsy there were severe emphysematous changes in all lung lobes and there was massive hemorrhage throughout the lungs. The liver weighed 860 grams and there was micronodular cirrhosis.