Hello Nick. Click on the three grey-stripes at the top and find Q+A on the menu. Your question is now at the top of that heap.
There was a lively discussion over the last few days about similar test results. You can also search for similar posts in the past about Spirometry and CT scans.
My curiosity would ask you: Are you a former heavy smoker or recent COVID survivor? Even so, your young age belies any traditional display of COPD. 🤔 IF your ailment came out of left field, nothing is definitive yet. Welcome to this Forum and all the Best.

my advice is get a second opinion and a another cat scan, good luck and god bless

Rolland has given you good information, and he's right that none of us are doctors. The question really isn't whether there is evidence of emphysema in the CT scan; it's really are you have any difficulties breathing because of the emphysematous changes that were noted on the CT scan. What often happens is that someone is given a spirometry of Pulmonary Function Test that shows COPD, and a CT scan is ordered to see more and to confirm what the PFT showed. The spirometry or PFT is the definitive diagnostic tool to determine loss of lung function; the CT scan is to confirm the diagnosis.

Another part of the answer is that emphysematous changes occur normally as things happen to us: we get pneumonia or chronic bronchitis or have a lung injury as a result of an accident. All those things can create physical changes in the lungs and would be caught by a CT scan. So it's quite possible to have emphysematous changes but have no breathing difficulties as a result.

What's happened to you is pretty common. You have a CT scan for something else and the radiologist reports emphysematous changes in the lungs. So for you things went backwards. What you see in the lungs in the CT scan may presage future changes, but as Rolland has said, you quit smoking and with luck, you may not have any further issues. If you do, you have already done the one thing that will really make a difference: no smoking. Start a regular exercise program and live a deliberately healthy life-style now and you will be way ahead of the game.

Thanks for the background info Nick. It's good that you have stopped all smoking, that is the best leg-up in this Race and for the long term!
You will find many different answers here because none of us are Doctors. (There are some former nurses and medical experts from other fields though). We all have a different understanding based on our own combination of illness and comprehension of these medical things. I like to research so it helps me to know a bit more than just getting through the day-to-day.
For me, Emphysema is A specific lung disease. COPD includes that and probably one or more other pulmonary issues (asthma, bronchitis, fibrosis, PH, aFib, etc.).
It's like having flour, eggs, butter and sugar in the cupboard. and Milk. Depending on the amount of each ingredient and the order you mix them you can bake a cake or cupcakes. Or make donuts. Even cookies!! Every body is different. COPD is an outward display of these conditions, not a primary disease in and of itself.
Keep in mind other heart and circulation issues can cause symptoms which mimic having COPD, along with certain medications, even OTC stuff. Take care.

I know pet scans are the best, but they are expensive. See if your insurance will cover it. Ask Dr. for a referral.