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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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Thickening of the bronchial wall in cases of pulmonary emphysema. High resolution computed tomography showing thickening of the bronchial wall and narrowing of the lumen (arrows).
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f26-copd-3-193: Thickening of the bronchial wall in cases of pulmonary emphysema. High resolution computed tomography showing thickening of the bronchial wall and narrowing of the lumen (arrows).

Mentions: COPD is considered to be a chronic inflammatory process throughout the airway and lung parenchyme, allowing definition of two phenotypes involving primarily parenchymal disease (emphysema) and primarily airway disease (Nakano et al 2002; Hoffman et al 2006). These two pathologies frequently coexist in a diseased lung. Pathological changes of the large airway include enlarged mucus-secreting glands and an increase in the number of goblet cells with mucus hypersecretion (Pauwels et al 2001). In the peripheral airways, chronic inflammation leads to repeated cycles of injury and repair of the airway wall (Pauwels et al 2001), and the repair process results in structural remodeling of the airway wall (Pauwels et al 2001). Quantitative measurement of the airway by HRCT is a promising method for evaluation of the inflammatory condition of the airway in COPD, and recent studies have shown that HRCT can be used to divide COPD patients into groups with predominant lower lung attenuation or thickening and narrowing of the airway, although many subjects have both abnormalities (Nakano et al 2002 Hoffman et al 2006) (Figure 26).


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)

Thickening of the bronchial wall in cases of pulmonary emphysema. High resolution computed tomography showing thickening of the bronchial wall and narrowing of the lumen (arrows).
© Copyright Policy
Related In: Results  -  Collection

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

f26-copd-3-193: Thickening of the bronchial wall in cases of pulmonary emphysema. High resolution computed tomography showing thickening of the bronchial wall and narrowing of the lumen (arrows).
Mentions: COPD is considered to be a chronic inflammatory process throughout the airway and lung parenchyme, allowing definition of two phenotypes involving primarily parenchymal disease (emphysema) and primarily airway disease (Nakano et al 2002; Hoffman et al 2006). These two pathologies frequently coexist in a diseased lung. Pathological changes of the large airway include enlarged mucus-secreting glands and an increase in the number of goblet cells with mucus hypersecretion (Pauwels et al 2001). In the peripheral airways, chronic inflammation leads to repeated cycles of injury and repair of the airway wall (Pauwels et al 2001), and the repair process results in structural remodeling of the airway wall (Pauwels et al 2001). Quantitative measurement of the airway by HRCT is a promising method for evaluation of the inflammatory condition of the airway in COPD, and recent studies have shown that HRCT can be used to divide COPD patients into groups with predominant lower lung attenuation or thickening and narrowing of the airway, although many subjects have both abnormalities (Nakano et al 2002 Hoffman et al 2006) (Figure 26).

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