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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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HRCT of the normal lung. The pulmonary artery supplies two secondary lobules, and arrows indicate branching of the intralobular pulmonary arteries. The corresponding airways cannot be seen.Abbreviations: HRCT, high resolution computed tomography; PA, pulmonary artery, PV, pulmonary vein.
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f7-copd-3-193: HRCT of the normal lung. The pulmonary artery supplies two secondary lobules, and arrows indicate branching of the intralobular pulmonary arteries. The corresponding airways cannot be seen.Abbreviations: HRCT, high resolution computed tomography; PA, pulmonary artery, PV, pulmonary vein.

Mentions: In general, HRCT can be used to visualize an airway with a diameter larger than 2 mm, which corresponds to sub-subsegmental bronchi (Murata et al 1986). These bronchi are generally located in the inner two-thirds of the lung field (Murata et al 1986). In the distal lung field, the course of the airway can be recognized from the branching structure of the pulmonary artery that accompanies the airway. CT shows the pulmonary artery down to a caliber of 200 μm (Murata et al 1986). This portion corresponds to the level of the tip of the terminal bronchioles and the 1st respiratory bronchioles (Itoh et al 1978, Murata et al 1986). Therefore, a centrilobular region can be recognized as an area around the tip of the visible pulmonary artery (Figures 6, 7). Centrilobular abnormalities always have a distance of about 2.5 mm from the perilobular structure, including interlobular septum, pleura and large pulmonary vessels (Murata et al 1986, 1989). Recent HRCT with thinner collimation (0.5–1.0 mm) has more powerful resolution for demonstration of peripheral lung structures, in which the distance between the most distal visible pulmonary artery and pleura is about 1–1.5 mm and that between the most distal visible airway and pleura is about 1.5 cm. The former corresponds to the level of 2nd respiratory bronchioles and the latter to prelobular bronchi (Takahashi et al 2002).


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)

HRCT of the normal lung. The pulmonary artery supplies two secondary lobules, and arrows indicate branching of the intralobular pulmonary arteries. The corresponding airways cannot be seen.Abbreviations: HRCT, high resolution computed tomography; PA, pulmonary artery, PV, pulmonary vein.
© Copyright Policy
Related In: Results  -  Collection

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

f7-copd-3-193: HRCT of the normal lung. The pulmonary artery supplies two secondary lobules, and arrows indicate branching of the intralobular pulmonary arteries. The corresponding airways cannot be seen.Abbreviations: HRCT, high resolution computed tomography; PA, pulmonary artery, PV, pulmonary vein.
Mentions: In general, HRCT can be used to visualize an airway with a diameter larger than 2 mm, which corresponds to sub-subsegmental bronchi (Murata et al 1986). These bronchi are generally located in the inner two-thirds of the lung field (Murata et al 1986). In the distal lung field, the course of the airway can be recognized from the branching structure of the pulmonary artery that accompanies the airway. CT shows the pulmonary artery down to a caliber of 200 μm (Murata et al 1986). This portion corresponds to the level of the tip of the terminal bronchioles and the 1st respiratory bronchioles (Itoh et al 1978, Murata et al 1986). Therefore, a centrilobular region can be recognized as an area around the tip of the visible pulmonary artery (Figures 6, 7). Centrilobular abnormalities always have a distance of about 2.5 mm from the perilobular structure, including interlobular septum, pleura and large pulmonary vessels (Murata et al 1986, 1989). Recent HRCT with thinner collimation (0.5–1.0 mm) has more powerful resolution for demonstration of peripheral lung structures, in which the distance between the most distal visible pulmonary artery and pleura is about 1–1.5 mm and that between the most distal visible airway and pleura is about 1.5 cm. The former corresponds to the level of 2nd respiratory bronchioles and the latter to prelobular bronchi (Takahashi et al 2002).

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