Types of Emphysema

This lung was dried and sliced. It shows the two major types of emphysema. What are they? Answer

In a closer view, another type of emphysema can be seen along the major fissure. What type is this? Answer

An infrequent type of emphysema is shown here at the lung apex. What is it? Answer

This section illustrates which type of emphysema? Answer

This photo is taken from a patient with alpha-1-antitrypsin deficiency-related emphysema. It shows an increased number of PMNs in capillaries (arrows and many more) and some alveolar and interstitial blood not thought to be related to the pneumonectomy. These PMNs can potentially digest the collagen and elastin of the alveolar wall (see discussion). Note the megakaryocyte in a capillary (arrowhead at top). Its function is not known, but any contribution of platelets would help to preserve the integrity of the capillary bed.

Clinical summary Discussion

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Answer: The lung shows panacinar (synonym: panlobular) emphysema in the apical segment. It shows centriacinar (synonym: centrilobular) emphysema in the remainder of the lung, but note that the upper lobe is involved more than the middle and lower lobes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: The darker region above the major fissure represents paraseptal (distal acinar) emphysema, which is absent along the minor fissure. Some paraseptal emphysema can also be seen in the whole section above in the subpleural regions of the upper lobe.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: This is an example of bullous emphysema. Note that the parenchyma not involved in the apical bullae appears normal in this case. Note also that although the bullae would probably appear unilocular by CT, fine septa are still present.

Giant bullous emphysema: Giant bullae consume more than 1/3 of a lung radiographically. The remainder of the parenchyma may be normal, as shown here, or have diffuse emphysema. Isolated bullae with normal lung may be associated with few symptoms until they enlarge sufficiently to compress normal lung and interfere with function [1]. Most are caused by cigarette smoking, but they may be seen in Marfan's and Ehlers-Danlos's syndromes and alpha-1-antitrypsin deficiency [2]). The risk of cancer in patients with bullous disease has been estimated at 32 times that of patients without bullae, and the average age at diagnosis of cancer is in the early 40s rather than the 60s as in usual lung cancer [2]. CT can distinguish cases with normal lung from those with diffuse emphysema [1]. Patients with bullae in otherwise normal lung are a subset of patients who may require lung volume reduction surgery. Minimal criteria for bullectomy include large (greater than 1/3 of a hemithorax) bullae and an FEV1 <50% predicted. Pulmonary function remains improved at 5 years in 30-50% of treated patients, and cessation of smoking is important in maintaining this improvement [1].  

Reference

1. Snider G. Reduction pneumoplasty for giant bullous emphysema. Implications for surgical treatment of nonbullous emphysema. Chest 1996; 109:540-548.

2. Zulueta J, Bloom S, Rozansky M, White A. Lung cancer in patients with bullous disease. Am J Respir Crit Care Med 1996; 154:519-522.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: This is centriacinar emphysema. Although the airway is not seen in this section, these emphysematous spaces occur in the vicinity of a bronchiole. Note that the more peripheral alveoli are intact.

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