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Emphysema

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Emphysema

  1. 1. Pulmonary EmphysemaPulmonary Emphysema Man B Paudyal IOM email : paudyalman82@gmail.com
  2. 2. Emphysema Definition: Abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls and without obvious fibrosis. Spaces in parenchyma > 1mm = Abnormal Emphysema causes dilation of air spaces by destruction of alveolar wall, leading to collapse of alveoli during expiration
  3. 3. Normal acinusNormal acinus
  4. 4. Lung comparisonLung comparison
  5. 5. EpidemiologyEpidemiology  Approximately 210 million people are affected worldwide leading to 3 million deaths annually. The cumulative effect of smoking and other environmental risk factors.  incidence,Men > women but with increased smoking and environmental risk factor exposure among women, the incidence is now equal between the sexes. Patients with genetic risk factors such as alpha-1-antitrypsin deficiency may present earlier according to phenotype. Risk factors include: smoking: by far the most common alpha-1-antitrypsin (AAT) deficiency intravenous injection of methylphenidate (Ritalin lung
  6. 6. classificationclassification Types of emphysema 1.Centriacinar 2. Panacinar 3. Paraseptal [Distal acinar] 4. Mixed & unclassified [Irregular]
  7. 7. Centriacinar : [ centrilobular, Proximal acinar ] • Dilatation of Respiratory Bronchiole • Upper lobes - severely involved • Can coexist with chronic bronchitis • Invariably occurs in smokers • Coal mine workers [carbon, dust] Panacinar Emphysema: • Whole of Acinus uniformly affected • Lower lobes severely involved • Association: … A1AT deficiency … Cigarette smokers
  8. 8. Centriacinar emphysemaCentriacinar emphysema. Central areas. Central areas show marked emphysematous damage (E),show marked emphysematous damage (E), surrounded by relatively spared alveolarsurrounded by relatively spared alveolar spaces. B,spaces. B, Panacinar emphysemaPanacinar emphysema involvinginvolving the entire pulmonary lobulentriathe entire pulmonary lobulentria
  9. 9. Paraseptal (Distal Acinar) • Localized along pleura - peripheral part of the acinus • Predisposes to spontaneous peumothorax • Adjacent to foci of fibrosis • Least common Mixed – IRREGULAR EMPHYSEMA: • MOST COMMON • LEAST SIGNIFICANT • COMMON AROUND SCAR TISSUE • COMBINATION OF TYPES
  10. 10. Pathogenesis • Protease and antiprotease theory AAT, A1MG • Oxidant-antioxidant imbalance SOD, Glutathione Alpha-1 Antitrypsin deficiency • 52 kD serum glycoprotein • Synthesis: liver, macrophage • Inhibits - Trypsin, Thrombin, Plasmin, Elastase • Gene: chromosome 14 [75 alleles] • Normal allele -- MM (90%) • * Deficiency -- ZZ
  11. 11. Pathogenesis emphysemaPathogenesis emphysema
  12. 12. Clinical presentationClinical presentation  The clinical features of emphysema should be distinguished from the signs and symptoms of chronic bronchitis. Patients with emphysema are hypocapnoeic and are often referred to as "pink puffers". This compares with the hypercapnoea and cyanosis of chronic bronchitis with patients referred to as "blue bloaters". In practice, features of these two syndromes coexist as chronic obstructive pulmonary disease. Patients typically report dyspnoea without significant sputum production. Signs of emphysema include:  tachypnoea  absence of cyanosis  pursed-lip breathing  chest hyperinflation  reduced breath sounds  hyper-resonant to percussion  cor pulmonale (late) Emphysema is best evaluated on CT, although indirect signs can be noticed on conventional radiography in a proportion of cases.
  13. 13. Chest radiograph ◦ increased AP diameter with flattened diaphragms ◦ hyperinflated lungs ◦ loss of lung markings ◦ elongated heart
  14. 14. Chest Xray of emphysema patientChest Xray of emphysema patient
  15. 15. Thank you For any suggestion Twitter : www.twitter.com/paudyalman82 email : paudyalman82@gmail.com Slideshare : slideshare.net/paudyalman82

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