2. 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.
38. 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.
α1 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.
