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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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Combined pulmonary fibrosis and pulmonary emphysema (CPFE) in a 59-year-old male who was a heavy smoker: High resolution computed tomography images.In the upper lung field (a), a prominent bullous change is apparent. In the middle lung field (b), tiny air cysts (arrows) with ground-glass opacity are present in addition to the bullous changes. In the lower lung field (c), distributed tiny air cysts with definable walls and ground-glass opacity are apparent. These features are consistent with interstitial fibrosis rather than pulmonary emphysema.
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f27-copd-3-193: Combined pulmonary fibrosis and pulmonary emphysema (CPFE) in a 59-year-old male who was a heavy smoker: High resolution computed tomography images.In the upper lung field (a), a prominent bullous change is apparent. In the middle lung field (b), tiny air cysts (arrows) with ground-glass opacity are present in addition to the bullous changes. In the lower lung field (c), distributed tiny air cysts with definable walls and ground-glass opacity are apparent. These features are consistent with interstitial fibrosis rather than pulmonary emphysema.

Mentions: Although not completely established, some patients with pulmonary emphysema in the upper lung field are reported to have simultaneous pulmonary fibrosis in the lower lung field (Wiggins et al 1990; Cottin et al 2005; Lundblad et al 2005; Grubstein et al 2005; Mura et al 2006) (Figure 27). Cottin and colleagues (2005) performed a retrospective analysis of 61 patients with emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lung on chest CT. These patients were characterized by subnormal spirometry, severe impairment of gas exchange, a high prevalence of pulmonary hypertension, and poor survival. The patients were almost exclusively male and all were current or ex-smokers. The pathophysiology of combined pulmonary fibrosis and pulmonary emphysema (CPFE) is unknown, but it is speculated that both emphysema and fibrosis may be related to a common environmental trigger or a genetic susceptibility factor. Smoking plays a central role and over-expression of TNF-α due to smoking may be important in producing emphysema and pulmonary fibrosis (Cottin et al 2005; Lundblad et al 2005; Gauldie et al 2006).


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)

Combined pulmonary fibrosis and pulmonary emphysema (CPFE) in a 59-year-old male who was a heavy smoker: High resolution computed tomography images.In the upper lung field (a), a prominent bullous change is apparent. In the middle lung field (b), tiny air cysts (arrows) with ground-glass opacity are present in addition to the bullous changes. In the lower lung field (c), distributed tiny air cysts with definable walls and ground-glass opacity are apparent. These features are consistent with interstitial fibrosis rather than pulmonary emphysema.
© Copyright Policy
Related In: Results  -  Collection

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

f27-copd-3-193: Combined pulmonary fibrosis and pulmonary emphysema (CPFE) in a 59-year-old male who was a heavy smoker: High resolution computed tomography images.In the upper lung field (a), a prominent bullous change is apparent. In the middle lung field (b), tiny air cysts (arrows) with ground-glass opacity are present in addition to the bullous changes. In the lower lung field (c), distributed tiny air cysts with definable walls and ground-glass opacity are apparent. These features are consistent with interstitial fibrosis rather than pulmonary emphysema.
Mentions: Although not completely established, some patients with pulmonary emphysema in the upper lung field are reported to have simultaneous pulmonary fibrosis in the lower lung field (Wiggins et al 1990; Cottin et al 2005; Lundblad et al 2005; Grubstein et al 2005; Mura et al 2006) (Figure 27). Cottin and colleagues (2005) performed a retrospective analysis of 61 patients with emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lung on chest CT. These patients were characterized by subnormal spirometry, severe impairment of gas exchange, a high prevalence of pulmonary hypertension, and poor survival. The patients were almost exclusively male and all were current or ex-smokers. The pathophysiology of combined pulmonary fibrosis and pulmonary emphysema (CPFE) is unknown, but it is speculated that both emphysema and fibrosis may be related to a common environmental trigger or a genetic susceptibility factor. Smoking plays a central role and over-expression of TNF-α due to smoking may be important in producing emphysema and pulmonary fibrosis (Cottin et al 2005; Lundblad et al 2005; Gauldie et al 2006).

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