Emphysema

Dr / Hytham nafady

Definition
Permanent dilatation of the air spaces
distal to terminal bronchiole,
accompanied by destruction of their
alveolar walls.
N.B:
COPD is a clinical term & includes
asthma,
bronchitis &
emphysema.

Respiratory

Conducting

Etiology
Imbalance between
elastase & anti-elastase systems.

C.P
Dyspnea

Hyperinflation

Signs of hyperinflation

Barrel shaped chest

AP / transverse ratio >

Horizontal ribs

Horizontal ribs

Low flat diaphragm

Low:
< 7th rib ant.
<10th rib post.
Flat:
Blunt CP angle

Low flat diaphragm

Low:
< 7th rib ant.
<10th rib post.
Flat:
Blunt CP angle

Widening of the retro-sternal clear space

Tubular
heart

Tubular
heart

< 30%

Saber sheath trachea

Pulmonary hypertension

Pulmonary hypertension

Pulmonary hypertension
Dilatation of pulmonary artery > aorta.
Pruning of pulmonary vasculature.

1ry Pulmonary hypertension

MS

Emphysematous bullae
(bullous emphysema)

Giant bullous emphysema

(vanishing lung syndrome)
Emphysematous bullae occupy more than
1/3 of the hemithorax).

Thin walled air spaces

Bleb
(pocket of air within the visceral pleura)

Cyst

Pneumatocele
(following staph pneumonia)

HRCT of emphysema
Well defined areas of abnormally
decreased attenuation without
defined wall.

2ry pulmonary lobule

Respiratory bronchiole

Centrilobular E
Synonyms:

Panlobular E

Paraseptal E

Paracicatricial E

Centriacinar emphysema.

Panacinar emphysema.

Distal acinar emphysema.

Irregular emphysema.

Dilatation of the
respiratory bronchioles
(in the central portion of
the acini).

Dilatation of the entire

acinus from respiratory
bronchioles to alveolar
sacs.

Dilatation of the alveolar

ducts & alveolar sacs.

No consistent
relationship to any
portion of 2ry lobule.

Pathology:

Normal &
emphysematous alveolar
spaces adjacent to each
other

Uniform enlargement of
all acini through both
lungs.

Focal areas of
emphysematous changes
adjacent to normal lung.

Emphysematous changes
adjacent to areas of
pulmonary scarring.

Site:

Lung apex.
Central areas

Lung base

Subpleural lung.

Adjacent to areas of
pulmonary scarring.

Aetiology:

Smoking.

1 anti-trypsin deficiency
IV drug abusers

Smoking

Pulmonary scarring

Chest xray:

Signs of hyperinflation.
Signs of pulmonary hypertension.
Emphysematous bullae.

High
resolution
CT:

Emphysematous spaces:
Focal areas of decreased
attenuation,
More than 1 cm,
Without definable wall.
Surrounded by a normal
lung,
Contains a central dot
(pulmonary arteriole).

Peripheral (subpleural
and peribronchovascular)
areas of decreased
attenuation less than
1cm.
(if more than 1 cm it is
considered subpleural
bullae).

Areas of decreased
attenuation adjacent to
pulmonary fibrosis.

Diffuse decrease in lung

attenuation.
Pulmonary vascular
pruning.
Difficult to detect early,
because of lack of
adjacent normal lung.

Associated with traction

bronchiectasis.

Centrilobular emphysema

Panlobular emphysema

Paraseptal emphysema

Congenital lobar emphysema

Congenital lobar emphysema

Congenital lobar emphysema

DD
CCAM
Unilateral hypertranslucency with
multiple cysts

Bronchial atresia
Unilateral hypertransulcency with
mucoid impaction

Pulmonary interstitial emphysema

Mechanical ventillation
RDS

Pulmonary interstitial
emphysema

IPE with
pneumothorax

IPE with
pneumomediastinu
m

Persistent pulmonary interstitial emphysema

Multiple cystic lucencies with central line & dot
pattern.

Quiz

Findings
Bilateral lower zones predominant
emphysema (panacinar emphysema)
Liver cirrhosis.
Right hepatic lobe focal lesion.

Diagnosis
alpha 1 anti-trypsin deficiency

Panlobular
emphysema
ritaline I.V
abuse