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Emphysema Emphysema Presentation Transcript

  • 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.
  • eR gnt c udno C i
  • Etiology • Imbalance between elastase & anti-elastase systems.
  • C.P Dyspnea
  • Hyperinflation
  • Signs of hyperinflation
  • Barrel shaped chest AP / transverse ratio > ½
  • 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. 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.
  • 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