Professional Documents
Culture Documents
Emphysema
Lung Collapse
Pulmonary Emphysema
LUNG DISEASES
To remind you, emphysema is one of the
major diffuse obstructive diseases,
diseases which
include as well chronic bronchitis, bronchial
asthma, & bronchiectasis. In these patients
there is limitation of maximal airflow rates
during forced expiration (increased
resistance to airflow).
Expiratory airflow obstruction may result
from airway narrowing as in asthma or from
loss of elastic recoil which characteristically
occurs in emphysema.
LUNG DISEASES
Diffuse pulmonary diseases can be classified into 2 categories
Obstructive Disease
Restrictive Disease
It is ch.ch. by increased
resistance to airflow due to
narrowing)
4. Bronchiectasis
5. Cystitis fibrosis
6. Bronchiolitis
Normal Anatomy
Pulmonary Emphysema
Lung
Lobule
Lung Lobule
=3 - 5 Respiratory Acini
Terminal bronchiole
Respiratory bronchiole
Alveolar duct
Alveoli
Respiratory Acinus
Pulmonary Emphysema
Microanatomy: The
acinus is the part of
the lung distal to the
terminal bronchiole
and includes
respiratory
bronchiole,
alveolar ducts and
alveoli.
Pulmonary Emphysema
Pulmonary Emphysema
Definition: It is characterized by
permanent enlargement of airspaces
distal to the terminal bronchiole (respiratory
bronchioles, alveolar ducts & alveoli)
accompanied by
Classification of Emphysema
Emphysema is classified according to its
anatomic classification within the lobule
(cluster of acini , the alveolated respiratory
units).
There are 4 major types:
1.centriacinar, 2.panacinar, 3.paraseptal ,
and 4. irregular. Of these, only the first two
cause clinically significant obstruction.
N.B. Centriacinar is far more common than
panacinar form, constituting more than
95% of cases
Types of Emphysema
1.Centrilobular (Centriacinar) Emphysema
1.Centrilobular (Centriacinar)
Emphysema
Alveolar
duct
Respiratory
bronchiole
Alveoli
In severe cases
of centriacinar
emphysema
the distal
acinus
becomes
involved thus
the distinction
from panacinar
emphysema
becomes
difficult.
difficult
Alveolar
ducts &
alveoli
Pathogenesis of Emphysema
2 critical imbalances:
A. protease antiprotease) B. (Oxidant antioxidant)
Alpha 1 antitrypsin is synthesized by liver,
present in serum, tissue fluid & macrophages)
has antiprotease activity (inhibits elastolytic
activity)
Protease is secreted by neutrophils and
macrophages ( it has elastolytic activity)
O free radical inhibits the function of the alpha 1
antitrypsin ( it is present in smoke & can be
secreted by activated neutrophils)
Pathogenesis of Emphysema
If alpha 1 antitrypsin is decreased
(deficiency or functional deficiency by O
free radical)
or
If protease is increased by inflammation
(chronic bronchitis) or smoking
(chemoattraction of N & M)
Imbalance results & destruction occurs
Pathogenesis of Emphysema
with
Increased protease
(elastase) & as well O2
free radical (inhibit
alpha 1 activity)
Unchecked
tissue
destruction
Emphysema
In smokers:
Tobacco
Pathogenesis of
Emphysema
Tobacco
Nicotine
Chemoattraction of
neutrophils from the
capillaries to the
respiratory acinus
Increase no. of
neutrophils
Reactive O2 free
radical
Inactivation of anti
-protease (functional
deficiency)=oxidative inactivation
Neutrophil
elastase &
other proteases
Tissue
destruction
*Alveolar
macrophage
secretes
macrophage
elastase&
other proteases
Pathogenesis of Emphysema
Smoke particles are
impacted at respiratory
bronchiole result in
increased influx of
neutrophils & macrophages
both of which secrete
proteases
Smoke-induced oxidative
damage (O free radical)
results in functional
deficiency of alpha
antitrypsin
This results in uncontrolled
proteolysis & destruction of elastic
tissue in centriacinar region.
Pathogenesis of Emphysema
Emphysema
Emphysema
Microscopically:
There is thinning and
destruction of alveolar walls.
The adjacent alveoli become
confluent creating large air
spaces.
Fibrosis and chronic
inflammation around
bronchioles occur with the
loss of elastic tissue in the
surrounding alveolar septa in
cases associated with chronic
bronchitis.
(leading
to polycythaemia)
Root of the
neck
Mediastinal &
subcutaneous
(interstitial)
Emphysema
Interstitial subcutaneous
emphysema
(subcutaneous crepitation)
Fractured clavicle
1. Compression Collapse
Left pleural
effusion: The
mediastinum
is shifted
away from the
collapsed side
(Left side)
Rt is Normal, the mediastinum is shifted
to the rt.
Acute
complete
obstruction by:
1.foreign body
(children),
2. mucus or
mucopurulent
plug (chronic
Chronic obstruction
by 1.tumors in
bronchial wall or
pressure on the wall
2.from outside by
enlarged hilar L.N. or an
aneurysm.
bronchitis or
bronchiectasis) or
3.blood clots during
surgery.
Pathogenesis:
Pathogenesis After obstruction collateral air ventilation
may keep the obstructed segment for a time. Later air is
replaced by secretions which may lead to infection.
infection
Compare
Compare
Compression Collapse
Absorption Collapse
Vascular 2007
Gross
Mcs
1. Slit like opening of the alveoli & pulmonary
arterioles are constricted.
2. If not treated: proliferation of pneumocytes
occur, progressive pulmonary fibrosis & intimal
fibroelastosis of pulmonary arterioles