Emphysema
Dr / Hytham nafady
Definition
• Permanent dilatation of the air spaces
distal to terminal bronchiole,
accompanied by destruction of their
alv...
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.

D...
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 impac...
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...
Diagnosis
• alpha 1 anti-trypsin deficiency
Panlobular
emphysema
ritaline I.V
abuse
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
Emphysema
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Emphysema

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Emphysema

  1. 1. Emphysema Dr / Hytham nafady
  2. 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. 3. eR gnt c udno C i
  4. 4. Etiology • Imbalance between elastase & anti-elastase systems.
  5. 5. C.P Dyspnea
  6. 6. Hyperinflation
  7. 7. Signs of hyperinflation
  8. 8. Barrel shaped chest AP / transverse ratio > ½
  9. 9. Horizontal ribs
  10. 10. Horizontal ribs
  11. 11. Low flat diaphragm Low: • < 7th rib ant. • <10th rib post. Flat: • Blunt CP angle
  12. 12. Low flat diaphragm Low: • < 7th rib ant. • <10th rib post. Flat: • Blunt CP angle
  13. 13. Widening of the retro-sternal clear space
  14. 14. Tubular heart
  15. 15. Tubular heart < 30%
  16. 16. Saber sheath trachea
  17. 17. Pulmonary hypertension
  18. 18. Pulmonary hypertension
  19. 19. Pulmonary hypertension • Dilatation of pulmonary artery > aorta. • Pruning of pulmonary vasculature.
  20. 20. 1ry Pulmonary hypertension
  21. 21. MS
  22. 22. Emphysematous bullae (bullous emphysema)
  23. 23. Giant bullous emphysema (vanishing lung syndrome) • Emphysematous bullae occupy more than 1/3 of the hemithorax).
  24. 24. Thin walled air spaces
  25. 25. Bleb (pocket of air within the visceral pleura)
  26. 26. Cyst
  27. 27. Pneumatocele (following staph pneumonia)
  28. 28. HRCT of emphysema • Well defined areas of abnormally decreased attenuation without defined wall.
  29. 29. 2ry pulmonary lobule Respiratory bronchiole
  30. 30. 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.
  31. 31. Centrilobular emphysema
  32. 32. Panlobular emphysema
  33. 33. Paraseptal emphysema
  34. 34. Congenital lobar emphysema
  35. 35. Congenital lobar emphysema
  36. 36. Congenital lobar emphysema
  37. 37. DD CCAM Unilateral hypertranslucency with multiple cysts Bronchial atresia Unilateral hypertransulcency with mucoid impaction
  38. 38. Pulmonary interstitial emphysema
  39. 39. Mechanical ventillation RDS Pulmonary interstitial emphysema
  40. 40. IPE with pneumothorax IPE with pneumomediastinu m
  41. 41. Persistent pulmonary interstitial emphysema • Multiple cystic lucencies with central line & dot pattern.
  42. 42. Quiz
  43. 43. Findings • Bilateral lower zones predominant emphysema (panacinar emphysema) • Liver cirrhosis. • Right hepatic lobe focal lesion.
  44. 44. Diagnosis • alpha 1 anti-trypsin deficiency
  45. 45. Panlobular emphysema ritaline I.V abuse
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