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Imaging of pulmonary emphysema: a pictorial review.

Takahashi M, Fukuoka J, Nitta N, Takazakura R, Nagatani Y, Murakami Y, Otani H, Murata K - Int J Chron Obstruct Pulmon Dis (2008)

Bottom Line: In panlobular emphysema, HRCT shows either panlobular low attenuation or ill-defined diffuse low attenuation of the lung.Paraseptal emphysema is characterized by subpleural well-defined cystic spaces.Recent topics related to imaging of pulmonary emphysema will also be discussed, including morphometry of the airway in cases of chronic obstructive pulmonary disease, combined pulmonary fibrosis and pulmonary emphysema, and bronchogenic carcinoma associated with bullous lung disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan. masashi@belle.shiga-med.ac.jp

ABSTRACT
The term 'emphysema' is generally used in a morphological sense, and therefore imaging modalities have an important role in diagnosing this disease. In particular, high resolution computed tomography (HRCT) is a reliable tool for demonstrating the pathology of emphysema, even in subtle changes within secondary pulmonary lobules. Generally, pulmonary emphysema is classified into three types related to the lobular anatomy: centrilobular emphysema, panlobular emphysema, and paraseptal emphysema. In this pictorial review, we discuss the radiological--pathological correlation in each type of pulmonary emphysema. HRCT of early centrilobular emphysema shows an evenly distributed centrilobular tiny areas of low attenuation with ill-defined borders. With enlargement of the dilated airspace, the surrounding lung parenchyma is compressed, which enables observation of a clear border between the emphysematous area and the normal lung. Because the disease progresses from the centrilobular portion, normal lung parenchyma in the perilobular portion tends to be preserved, even in a case of far-advanced pulmonary emphysema. In panlobular emphysema, HRCT shows either panlobular low attenuation or ill-defined diffuse low attenuation of the lung. Paraseptal emphysema is characterized by subpleural well-defined cystic spaces. Recent topics related to imaging of pulmonary emphysema will also be discussed, including morphometry of the airway in cases of chronic obstructive pulmonary disease, combined pulmonary fibrosis and pulmonary emphysema, and bronchogenic carcinoma associated with bullous lung disease.

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Secondary pulmonary lobule: Reid’s definition. Contact radiograph of the inflated fixed lung specimen showing the branching terminal bronchioles (arrows). These terminal bronchioles arise at intervals of 1 to 2 mm. The bar represents 5 mm.Abbreviations: BR, bronchus; PA, pulmonary artery; PV, pulmonary vein; ILS, interlobular septum.
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f1-copd-3-193: Secondary pulmonary lobule: Reid’s definition. Contact radiograph of the inflated fixed lung specimen showing the branching terminal bronchioles (arrows). These terminal bronchioles arise at intervals of 1 to 2 mm. The bar represents 5 mm.Abbreviations: BR, bronchus; PA, pulmonary artery; PV, pulmonary vein; ILS, interlobular septum.

Mentions: An understanding of the normal anatomy of the peripheral lung is required when interpreting CT images of pulmonary emphysema. From the trachea, airways with a diameter of 1 mm reach the level of the lobular bronchus after 9 to 14 dichotomous branches. Lobular bronchus has 3 to 5 smaller airways, which are called terminal bronchioles (Figure 1). These bronchioles arise at intervals of 1 to 2 mm while pre-lobular bronchi arise at intervals of 0.5 to 1.0 cm (Reid 1958). A unit consisting of 3 to 5 terminal bronchioles supplied by a small bronchus with a diameter of 1 mm is called a secondary pulmonary lobule (Reid’s lobule) (Reid 1958). Therefore, an intralobular region can be recognized if the branching distance is constant at 1 to 2 mm. Prelobular branching is referred to as a “cm pattern” and an intralobular pattern is called an “mm pattern” (Reid 1958) (Figure 2), and the area supplied by each terminal bronchiole is called an “acinus”. Miller (1950) defined the secondary lobule as an area surrounded by the interlobular septum (Figure 3). Reid’s and Miller’s lobules are not conceptually the same, because the interlobular septum is not constantly and uniformly observed within the lung, and the area surrounded by the septum ranges from 1 to 3 cm; in contrast, Reid’s lobule is constantly and uniformly observed throughout the lung (Itoh et al 1993).


Imaging of pulmonary emphysema: a pictorial review.

Takahashi M, Fukuoka J, Nitta N, Takazakura R, Nagatani Y, Murakami Y, Otani H, Murata K - Int J Chron Obstruct Pulmon Dis (2008)

Secondary pulmonary lobule: Reid’s definition. Contact radiograph of the inflated fixed lung specimen showing the branching terminal bronchioles (arrows). These terminal bronchioles arise at intervals of 1 to 2 mm. The bar represents 5 mm.Abbreviations: BR, bronchus; PA, pulmonary artery; PV, pulmonary vein; ILS, interlobular septum.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2629965&req=5

f1-copd-3-193: Secondary pulmonary lobule: Reid’s definition. Contact radiograph of the inflated fixed lung specimen showing the branching terminal bronchioles (arrows). These terminal bronchioles arise at intervals of 1 to 2 mm. The bar represents 5 mm.Abbreviations: BR, bronchus; PA, pulmonary artery; PV, pulmonary vein; ILS, interlobular septum.
Mentions: An understanding of the normal anatomy of the peripheral lung is required when interpreting CT images of pulmonary emphysema. From the trachea, airways with a diameter of 1 mm reach the level of the lobular bronchus after 9 to 14 dichotomous branches. Lobular bronchus has 3 to 5 smaller airways, which are called terminal bronchioles (Figure 1). These bronchioles arise at intervals of 1 to 2 mm while pre-lobular bronchi arise at intervals of 0.5 to 1.0 cm (Reid 1958). A unit consisting of 3 to 5 terminal bronchioles supplied by a small bronchus with a diameter of 1 mm is called a secondary pulmonary lobule (Reid’s lobule) (Reid 1958). Therefore, an intralobular region can be recognized if the branching distance is constant at 1 to 2 mm. Prelobular branching is referred to as a “cm pattern” and an intralobular pattern is called an “mm pattern” (Reid 1958) (Figure 2), and the area supplied by each terminal bronchiole is called an “acinus”. Miller (1950) defined the secondary lobule as an area surrounded by the interlobular septum (Figure 3). Reid’s and Miller’s lobules are not conceptually the same, because the interlobular septum is not constantly and uniformly observed within the lung, and the area surrounded by the septum ranges from 1 to 3 cm; in contrast, Reid’s lobule is constantly and uniformly observed throughout the lung (Itoh et al 1993).

Bottom Line: In panlobular emphysema, HRCT shows either panlobular low attenuation or ill-defined diffuse low attenuation of the lung.Paraseptal emphysema is characterized by subpleural well-defined cystic spaces.Recent topics related to imaging of pulmonary emphysema will also be discussed, including morphometry of the airway in cases of chronic obstructive pulmonary disease, combined pulmonary fibrosis and pulmonary emphysema, and bronchogenic carcinoma associated with bullous lung disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan. masashi@belle.shiga-med.ac.jp

ABSTRACT
The term 'emphysema' is generally used in a morphological sense, and therefore imaging modalities have an important role in diagnosing this disease. In particular, high resolution computed tomography (HRCT) is a reliable tool for demonstrating the pathology of emphysema, even in subtle changes within secondary pulmonary lobules. Generally, pulmonary emphysema is classified into three types related to the lobular anatomy: centrilobular emphysema, panlobular emphysema, and paraseptal emphysema. In this pictorial review, we discuss the radiological--pathological correlation in each type of pulmonary emphysema. HRCT of early centrilobular emphysema shows an evenly distributed centrilobular tiny areas of low attenuation with ill-defined borders. With enlargement of the dilated airspace, the surrounding lung parenchyma is compressed, which enables observation of a clear border between the emphysematous area and the normal lung. Because the disease progresses from the centrilobular portion, normal lung parenchyma in the perilobular portion tends to be preserved, even in a case of far-advanced pulmonary emphysema. In panlobular emphysema, HRCT shows either panlobular low attenuation or ill-defined diffuse low attenuation of the lung. Paraseptal emphysema is characterized by subpleural well-defined cystic spaces. Recent topics related to imaging of pulmonary emphysema will also be discussed, including morphometry of the airway in cases of chronic obstructive pulmonary disease, combined pulmonary fibrosis and pulmonary emphysema, and bronchogenic carcinoma associated with bullous lung disease.

Show MeSH
Related in: MedlinePlus