CT Findings

The left upper lobe has a spiculated nodule about 1 cm in diameter. Note the severe emphysema bilaterally.

Radiographic changes: Plain radiographs are an insensitive measure for detecting and estimating the severity of emphysema. With significant disease, chest radiographs show hyperinflation with increased A-P diameter, increased retrosternal air space, and flattened diaphragms. Vascular markings may be decreased peripherally, and radiolucent bullae may be present. Hilar pulmonary arteries dilate as hypertension develops [1].

HRCT: HRCT scans are much more sensitive than plain films for diagnosing emphysema, even at early stages [2,3]. Scoring of degree of emphysema in HRCT scans correlates well with scoring in pathologic specimens [3].

References

1. Snider G, Faling L, Rennard S. Chronic bronchitis and emphysema. In: J Murray, J Nadel (eds.): Textbook of Respiratory Medicine, 2nd ed. Philadelphia, WB Saunders, 1994, pp 1331-1397.

2. Klein J, Gamsu G, Webb W, Golden J, Müller N. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiology 1992; 182:817-821.

3. Kuwano K, Matsuba K, Ikeda T, Murakami J, Araki A, Nishitani H, Ishida T, et al. The diagnosis of mild emphysema. Correlation of computed tomography and pathology scores. Am Rev Respir Dis 1990; 141:169-178.

Clinical summary Image 1

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