Limits...
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.

Show MeSH

Related in: MedlinePlus

Panacinar emphysema. On high resolution computed tomography, diffuse low attenuation changes are observed throughout the lung field. A localized LAA is not apparent.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2629965&req=5

f20-copd-3-193: Panacinar emphysema. On high resolution computed tomography, diffuse low attenuation changes are observed throughout the lung field. A localized LAA is not apparent.

Mentions: Two types of disease distribution have been recognized in panacinar emphysema: a localized form and a diffuse form (Thurlbeck 1995) (Figure 18). The former has a multilobular distribution and the latter has a distribution that is not related to the zonal anatomy of the lung. The striking difference from centriacinar emphysema is the low contrast to the neighboring normal lung (Stern and Frank 1994). The low attenuation of centriacinar emphysema is easily recognized on HRCT because of the contrast between the emphysematous region and the normal lung, whereas panacinar emphysema does not show a difference in intralobular attenuation because the entire lobule is involved to almost the same extent. Yamagishi and colleagues (1991) reported several CT-pathological observations in cases of panacinar emphysema, as follows: the low attenuation region is not evenly distributed within the lobule or lobule-by-lobule on HRCT, which is attributed to an uneven distribution of the degree of the disease; the caliber of the vessels in the involved area is decreased due to overinflation of the air space; the localized form of panacinar emphysema has a polygonal border, which represents the interlobular septum, and perilobular large vessels are observed at the border of the lesion (Figure 19); and the margin of the diffuse form of panacinar emphysema is ill defined, due to the inhomogeneity of the intralobular disease distribution in lobules located at the periphery of the lesion (Figures 20, 21).


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)

Panacinar emphysema. On high resolution computed tomography, diffuse low attenuation changes are observed throughout the lung field. A localized LAA is not apparent.
© Copyright Policy
Related In: Results  -  Collection

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

f20-copd-3-193: Panacinar emphysema. On high resolution computed tomography, diffuse low attenuation changes are observed throughout the lung field. A localized LAA is not apparent.
Mentions: Two types of disease distribution have been recognized in panacinar emphysema: a localized form and a diffuse form (Thurlbeck 1995) (Figure 18). The former has a multilobular distribution and the latter has a distribution that is not related to the zonal anatomy of the lung. The striking difference from centriacinar emphysema is the low contrast to the neighboring normal lung (Stern and Frank 1994). The low attenuation of centriacinar emphysema is easily recognized on HRCT because of the contrast between the emphysematous region and the normal lung, whereas panacinar emphysema does not show a difference in intralobular attenuation because the entire lobule is involved to almost the same extent. Yamagishi and colleagues (1991) reported several CT-pathological observations in cases of panacinar emphysema, as follows: the low attenuation region is not evenly distributed within the lobule or lobule-by-lobule on HRCT, which is attributed to an uneven distribution of the degree of the disease; the caliber of the vessels in the involved area is decreased due to overinflation of the air space; the localized form of panacinar emphysema has a polygonal border, which represents the interlobular septum, and perilobular large vessels are observed at the border of the lesion (Figure 19); and the margin of the diffuse form of panacinar emphysema is ill defined, due to the inhomogeneity of the intralobular disease distribution in lobules located at the periphery of the lesion (Figures 20, 21).

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