PATHOLOGY

1. Emphysema
KHAWAJA TAIMOOR SHAHID
M.Phil Zoology, M.Ed
Department of Zoology
Superior College M.B.DiN

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

3. Emphysema
Emphysema causes dilation of air
spaces by destruction of alveolar wall,
leading to collapse of alveoli during
expiration

4. Emphysema & Overinflation
• Emphysema: Increased air space with
destruction
• Overinflation: Increased air space without
destruction

5. Classification: Types of emphysema
1. Centriacinar
2. Panacinar
3. Paraseptal [Distal acinar]
4. Mixed & unclassified [Irregular]

6. 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]

7. Panacinar Emphysema:
• Whole of Acinus uniformly affected
• Lower lobes severely involved
• Association:
… A1AT deficiency
… Cigarette smokers
A1AT= Alpha-1 antitrypsin deficiency (AAT
deficiency) is an inherited condition that raises
your risk for lung and liver disease

8. Paraseptal (Distal Acinar)
• Localized along pleura - peripheral part
of the acinus; a region of the lung
supplied with air from one of the terminal
bronchioles.
• Predisposes to spontaneous peumothorax
• Adjacent to foci of fibrosis ; represent
microscopic zones of acute lung injury
• Least common

9. Mixed – IRREGULAR EMPHYSEMA:
• MOST COMMON
• LEAST SIGNIFICANT
• COMMON AROUND SCAR TISSUE
• COMBINATION OF TYPES
• Scar tissue is a collection of cells and
collagen that covers the site of the injury.

10. Etiology
• Cigarette smoking [20 - 40% smokers]
• Air pollution
• Alpha-1-antitrypsin deficiency

11. Clinical picture
• Dysponea
• Cough with or without expectoration
• Wheezing
• Loss of weight
• Peptic ulceration
• Hypercapnia > changes in central
nervous system
• Barrel chest

12. Barrel chest

13. Obstructive Pulmonary diseases
• Disorders Associated with Airflow
Obstruction
• Chronic bronchitis, Emphysema, Asthma,
Bronchiectasis & Bronchiolitis come under
this category

14. Venn diagram of chronic obstructive pulmonary disease (COPD).
Chronic obstructive lung disease is a disorder in which subsets of
patients may have dominant features of chronic bronchitis,
emphysema, or asthma. The result is irreversible airflow obstruction.

15. COPD
• COPD: Comprises Emphysema and chronic
bronchitis
• Many patients have overlapping features of
damage at both the acinar level (emphysema) and
bronchial level (bronchitis)
• Common extrinsic trigger— cigarette smoking —
is implicated in both the diseases

16. Figure 15-9 Schematic representation of evolution of
chronic bronchitis (left) and emphysema (right).

18. “Pink Puffer”
Emphysema
Thin
Dysponea
< Vital capacity
> Lung volume

19. “Blue Bloater” – Chronic bronchitis

20. Table 15-4 -- Emphysema and Chronic Bronchitis
Predominant Bronchitis Predominant Emphysema
Age (yr) 40–45 50–75
Dyspnea Mild; late Severe; early
Cough Early; copious sputum Late; scanty sputum
Infections Common Occasional
Respiratory insufficiency Repeated Terminal
Cor pulmonale Common Rare; terminal
Airway resistance Increased Normal or slightly increased
Elastic recoil Normal Low
Chest radiograph Prominent vessels; large heart Hyperinflation; small heart
Appearance Blue bloater Pink puffer

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