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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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Moderately progressed centriacinar emphysema. On high resolution computed tomography, a “wall” structure is observed at the periphery of the emphysema (arrows), composed of compressed lung tissue and perilobular vessels.
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f15-copd-3-193: Moderately progressed centriacinar emphysema. On high resolution computed tomography, a “wall” structure is observed at the periphery of the emphysema (arrows), composed of compressed lung tissue and perilobular vessels.

Mentions: The characteristic appearance of a gross specimen of centriacinar emphysema is pigmentation (anthracosis) in a patchy fashion in the inner zone of the lung (Figure 10). This is one of the clues shows that centriacinar emphysema is closely associated with inhaled exogenous dust. The pigmented area corresponds to centriacinar dilatation of the airspace, but this area is not a simple unilocular space and is composed of aggregated and dilated small air spaces (Figures 11, 12). The surrounding lung parenchyma shows a normal appearance, but there is no border structure between these regions. Therefore, HRCT in early centriacinar emphysema shows evenly distributed centrilobular tiny areas of low attenuation with ill-defined borders (Naidich et al 1982) (Figure 13). Aggregation of the dilated small airspaces is observed as a single air space since this feature is beyond the spatial resolution of CT. With enlargement of the dilated airspace, the surrounding lung parenchyma is compressed, which enables a clear border to be observed between the emphysematous area and normal lung (Naidich et al 1982) (Figures 14, 15). Since the disease progresses from the centrilobular portion, the normal lung parenchyma in the perilobular portion tends to be preserved, even in advanced pulmonary emphysema (Figure 16). It is not uncommon for the lung parenchyma to be subtly preserved near the large airway and vessel in a case of severe emphysema, which indicates that the disease originated from the centrilobular portion (Figure 17). To understand the disease distribution, it is important to recognize the borders of the large airway and vessel as perilobular structures. The caliber of the vessel in the involved area decreases, which may be attributable to redistribution of pulmonary blood flow to the uninvolved area.


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)

Moderately progressed centriacinar emphysema. On high resolution computed tomography, a “wall” structure is observed at the periphery of the emphysema (arrows), composed of compressed lung tissue and perilobular vessels.
© Copyright Policy
Related In: Results  -  Collection

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

f15-copd-3-193: Moderately progressed centriacinar emphysema. On high resolution computed tomography, a “wall” structure is observed at the periphery of the emphysema (arrows), composed of compressed lung tissue and perilobular vessels.
Mentions: The characteristic appearance of a gross specimen of centriacinar emphysema is pigmentation (anthracosis) in a patchy fashion in the inner zone of the lung (Figure 10). This is one of the clues shows that centriacinar emphysema is closely associated with inhaled exogenous dust. The pigmented area corresponds to centriacinar dilatation of the airspace, but this area is not a simple unilocular space and is composed of aggregated and dilated small air spaces (Figures 11, 12). The surrounding lung parenchyma shows a normal appearance, but there is no border structure between these regions. Therefore, HRCT in early centriacinar emphysema shows evenly distributed centrilobular tiny areas of low attenuation with ill-defined borders (Naidich et al 1982) (Figure 13). Aggregation of the dilated small airspaces is observed as a single air space since this feature is beyond the spatial resolution of CT. With enlargement of the dilated airspace, the surrounding lung parenchyma is compressed, which enables a clear border to be observed between the emphysematous area and normal lung (Naidich et al 1982) (Figures 14, 15). Since the disease progresses from the centrilobular portion, the normal lung parenchyma in the perilobular portion tends to be preserved, even in advanced pulmonary emphysema (Figure 16). It is not uncommon for the lung parenchyma to be subtly preserved near the large airway and vessel in a case of severe emphysema, which indicates that the disease originated from the centrilobular portion (Figure 17). To understand the disease distribution, it is important to recognize the borders of the large airway and vessel as perilobular structures. The caliber of the vessel in the involved area decreases, which may be attributable to redistribution of pulmonary blood flow to the uninvolved area.

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