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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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Aging lung. Magnified photograph of a specimen showing slight enlargement of respiratory bronchioles and alveolar ducts. Clear destruction of the alveolar wall is not apparent.
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f25-copd-3-193: Aging lung. Magnified photograph of a specimen showing slight enlargement of respiratory bronchioles and alveolar ducts. Clear destruction of the alveolar wall is not apparent.

Mentions: The lung undergoes a set of morphological and functional changes with aging. These changes, which may also be the result of environmental pollutants rather than aging alone (Thurlbeck 1995), include dilatation of alveolar ducts and respiratory bronchioles without obvious destruction of the alveolar wall (Ryan et al 1965). This is not referred to as emphysema, since emphysema is defined as an abnormal enlargement of the air space accompanied by destruction of the alveolar walls. In contrast to dilatation of alveolar ducts and respiratory bronchioles, the size of the alveoli is reduced, a process that has been referred to as “ductectasia” (Ryan et al 1965) (Figures 24, 25). This aging change is reflected in the “rounds out” configuration of the lung in which the anteroposterior diameter is increased (Anderson et al 1964). HRCT findings of the aging lung have not been established, probably because the difference in attenuation accompanying the changes is small.


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)

Aging lung. Magnified photograph of a specimen showing slight enlargement of respiratory bronchioles and alveolar ducts. Clear destruction of the alveolar wall is not apparent.
© Copyright Policy
Related In: Results  -  Collection

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

f25-copd-3-193: Aging lung. Magnified photograph of a specimen showing slight enlargement of respiratory bronchioles and alveolar ducts. Clear destruction of the alveolar wall is not apparent.
Mentions: The lung undergoes a set of morphological and functional changes with aging. These changes, which may also be the result of environmental pollutants rather than aging alone (Thurlbeck 1995), include dilatation of alveolar ducts and respiratory bronchioles without obvious destruction of the alveolar wall (Ryan et al 1965). This is not referred to as emphysema, since emphysema is defined as an abnormal enlargement of the air space accompanied by destruction of the alveolar walls. In contrast to dilatation of alveolar ducts and respiratory bronchioles, the size of the alveoli is reduced, a process that has been referred to as “ductectasia” (Ryan et al 1965) (Figures 24, 25). This aging change is reflected in the “rounds out” configuration of the lung in which the anteroposterior diameter is increased (Anderson et al 1964). HRCT findings of the aging lung have not been established, probably because the difference in attenuation accompanying the changes is small.

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