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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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Terminal and respiratory bronchioles. Specimen photograph demonstrating ramification of the two 1st respiratory bronchioles (1RB) from the terminal bronchiole (TB). The respiratory bronchiole wall has alveolar pores. After branching of the respiratory bronchiole 2 to 3 times (2RB, 3RB), the number of alveolar fenestrations increases gradually and these eventually change into the alveolar duct and then the alveolar sac.
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f4-copd-3-193: Terminal and respiratory bronchioles. Specimen photograph demonstrating ramification of the two 1st respiratory bronchioles (1RB) from the terminal bronchiole (TB). The respiratory bronchiole wall has alveolar pores. After branching of the respiratory bronchiole 2 to 3 times (2RB, 3RB), the number of alveolar fenestrations increases gradually and these eventually change into the alveolar duct and then the alveolar sac.

Mentions: Terminal bronchioles branch off respiratory bronchioles which have walls with pores of alveoli. After 2 to 3 branches of respiratory bronchioles, the number of alveolar fenestrations increases gradually and these then change into alveolar ducts and sacs (Figure 4). The airway is essentially accompanied by the pulmonary artery, even at the level of secondary pulmonary lobules. The area around the terminal bronchiole and the 1st ordered respiratory bronchiole is called the “centrilobular portion” or “centriacinar portion” (Spencer 1985) (Figure 5). The pulmonary vein runs between the pulmonary segment and connects to the interlobular septum, which forms peripheral connective tissue together with the visceral pleura. The distance from the centrilobular portion to the peripheral structure, including the interlobular septum, pulmonary vein and pleura, is constant at about 2.5 mm (Itoh et al 1978; Murata et al 1986).


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)

Terminal and respiratory bronchioles. Specimen photograph demonstrating ramification of the two 1st respiratory bronchioles (1RB) from the terminal bronchiole (TB). The respiratory bronchiole wall has alveolar pores. After branching of the respiratory bronchiole 2 to 3 times (2RB, 3RB), the number of alveolar fenestrations increases gradually and these eventually change into the alveolar duct and then the alveolar sac.
© Copyright Policy
Related In: Results  -  Collection

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

f4-copd-3-193: Terminal and respiratory bronchioles. Specimen photograph demonstrating ramification of the two 1st respiratory bronchioles (1RB) from the terminal bronchiole (TB). The respiratory bronchiole wall has alveolar pores. After branching of the respiratory bronchiole 2 to 3 times (2RB, 3RB), the number of alveolar fenestrations increases gradually and these eventually change into the alveolar duct and then the alveolar sac.
Mentions: Terminal bronchioles branch off respiratory bronchioles which have walls with pores of alveoli. After 2 to 3 branches of respiratory bronchioles, the number of alveolar fenestrations increases gradually and these then change into alveolar ducts and sacs (Figure 4). The airway is essentially accompanied by the pulmonary artery, even at the level of secondary pulmonary lobules. The area around the terminal bronchiole and the 1st ordered respiratory bronchiole is called the “centrilobular portion” or “centriacinar portion” (Spencer 1985) (Figure 5). The pulmonary vein runs between the pulmonary segment and connects to the interlobular septum, which forms peripheral connective tissue together with the visceral pleura. The distance from the centrilobular portion to the peripheral structure, including the interlobular septum, pulmonary vein and pleura, is constant at about 2.5 mm (Itoh et al 1978; Murata et al 1986).

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