It is uncertain if there is any causative relationship between COVID-19 infection and the development of paraseptal emphysema and we describe a case of the incidental finding of paraseptal lucencies that mimicked emphysema in a COVID-19 patient with no history of active or passive smoking, connective tissue disease, alpha-1 antitrypsin deficiency, surfactant deficiency or occupational exposure. The gene discussed is SERPINA1; the disease is pulmonary emphysema.