1. Emphysema
Dr / Hytham nafady

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.

3. eR
gnt c udno C
i

4. Etiology
• Imbalance between
elastase & anti-elastase systems.

5. C.P
Dyspnea

7. Hyperinflation

8. Signs of hyperinflation

9. Barrel shaped chest
AP / transverse ratio > ½

10. Horizontal ribs

11. Horizontal ribs

12. Low flat diaphragm
Low:
• < 7th rib ant.
• <10th rib post.
Flat:
• Blunt CP angle

13. Low flat diaphragm
Low:
• < 7th rib ant.
• <10th rib post.
Flat:
• Blunt CP angle

15. Widening of the retro-sternal clear space

16. Tubular
heart

17. Tubular
heart
< 30%

18. Saber sheath trachea

20. Pulmonary hypertension

22. Pulmonary hypertension

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

24. 1ry Pulmonary hypertension

25. MS

26. Emphysematous bullae
(bullous emphysema)

27. Giant bullous emphysema
(vanishing lung syndrome)
• Emphysematous bullae occupy more than
1/3 of the hemithorax).

31. Thin walled air spaces

32. Bleb
(pocket of air within the visceral pleura)

33. Cyst

34. Pneumatocele
(following staph pneumonia)

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

37. 2ry pulmonary lobule
Respiratory bronchiole

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.

39. Centrilobular emphysema

41. Panlobular emphysema

43. Paraseptal emphysema

44. Congenital lobar emphysema

45. Congenital lobar emphysema

46. Congenital lobar emphysema

48. DD
CCAM
Unilateral hypertranslucency with
multiple cysts
Bronchial atresia
Unilateral hypertransulcency with
mucoid impaction

49. Pulmonary interstitial emphysema

51. Mechanical ventillation
RDS
Pulmonary interstitial
emphysema

52. IPE with
pneumothorax
IPE with
pneumomediastinu
m

53. Persistent pulmonary interstitial emphysema
• Multiple cystic lucencies with central line & dot
pattern.

54. Quiz

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

57. Diagnosis
• alpha 1 anti-trypsin deficiency

58. Panlobular
emphysema
ritaline I.V
abuse