Imaging of pulmonary emphysema: A pictorial review

Review

(3923) Views  (1977) Full article downloads

Authors: Masashi Takahashi, Junya Fukuoka, Norihisa Nitta, Ryutaro Takazakura, Yukihiro Nagatani, et al

Published Date June 2008 Volume 2008:3(2) Pages 193 - 204

DOI: http://dx.doi.org/10.2147/COPD.S2639

Masashi Takahashi¹, Junya Fukuoka², Norihisa Nitta¹, Ryutaro Takazakura¹, Yukihiro Nagatani¹, Yoko Murakami¹, Hideji Otani¹, Kiyoshi Murata¹

¹Department of Radiology, Shiga University of Medical Science, Shiga, Japan; ²Laboratory of Pathology, Toyama University Hospital, Toyama, Japan

Abstract: The term ‘emphysema’ is generally used in a morphological sense, and therefore imaging modalities have an important role in diagnosing this disease. In particular, high resolution computed tomography (HRCT) is a reliable tool for demonstrating the pathology of emphysema, even in subtle changes within secondary pulmonary lobules. Generally, pulmonary emphysema is classified into three types related to the lobular anatomy: centrilobular emphysema, panlobular emphysema, and paraseptal emphysema. In this pictorial review, we discuss the radiological – pathological correlation in each type of pulmonary emphysema. HRCT of early centrilobular emphysema shows an evenly distributed centrilobular tiny areas of low attenuation with ill-defined borders. With enlargement of the dilated airspace, the surrounding lung parenchyma is compressed, which enables observation of a clear border between the emphysematous area and the normal lung. Because the disease progresses from the centrilobular portion, normal lung parenchyma in the perilobular portion tends to be preserved, even in a case of far-advanced pulmonary emphysema. In panlobular emphysema, HRCT shows either panlobular low attenuation or ill-defined diffuse low attenuation of the lung. Paraseptal emphysema is characterized by subpleural well-defined cystic spaces. Recent topics related to imaging of pulmonary emphysema will also be discussed, including morphometry of the airway in cases of chronic obstructive pulmonary disease, combined pulmonary fibrosis and pulmonary emphysema, and bronchogenic carcinoma associated with bullous lung disease.

Keywords: pulmonary emphysema, HRCT, radiologic-pathologic correlation, pulmonary fibrosis, bronchus, lung cancer