Buzz Words
Alveolar destruction
Loss of elasticity
starting in the respiratory bronchiole and progressing toward the proximal and central portion of the secondary lobule
Normal (above) And Centrilobular Emphysema Starting at the Respiratory Bronchiole
Normal Acinus and Acinus in Emphysema Image on the left shows normal size and appearance of terminal bronchioles and alveoli. On the right the image shows the effects on the respiratory bronchioles and when severe, on the alveoli as well Ashley Davidoff MD TheCommonVein.net
Definition
Emphysema is an inflammatory disease of the lung
characterized
alveolar and small vessels destruction with
Loss of elasticity
starting in the respiratory bronchiole and progressing toward the proximal and central portion of the secondary lobule
clinically characterised by
shortness of breath, and other respiratory problems.
Caused by
Results
Structurally
alveolar wall destruction
progressive expansion of the acinus without fibrosis,
decreased lung elasticity,
architectural distortion of the capillary bed. loss of functioning surface are
Clinically
presents in middle age and older,
as a barrel chested
?pink-puffer,
breathing often with pursed lips, with
insidious and unrelenting dyspnea.
Diagnosis
CXR shows
hyperinflated lungs, with
propensity for the upper lobes,
flattened diaphragms and a
s carinatum)”barrel chest”
CT
Swiss Cheese appearance
areas of low attenuation correspond to the regions where the alveoli and bronchioles are enlarged due to destruction
resemble the appearance of holes or gaps, similar to the holes in Swiss cheese.
Lug Function tests
reduction in the maximal expiratory flow during forced exhalation. (decreased FEV1)
Treatment
bronchodilators,
diuretics,
corticosteroids,
antibiotics
low-flow oxygen,
pulmonary rehabilitation.
Centrilobular Emphysema Dilated Air Spaces Localized around a Bronchovascular Bundle.
Centrilobular Emphysema This drawing shows a secondary lobule with centrally located dilated airspaces starting with the respiratory bronchiole and extending to the proximal structures including the alveolar ducts, sacs and alveoli Ashley Davidoff TheCommonVein.net
Alveolar Wall Destruction Localized around a Bronchovascular Bundle.
Histology of Centrilobular Emphysema, Alveolar wall destruction is localized around a bronchovascular bundle. Courtesy Yale Rosen MD
Micrograph showing emphysema (left ? large empty spaces) and lung tissue with relative preservation of the alveoli (right) Low magnification micrograph of emphysema. H&E stain. The left of image shows severe emphysema (large empty spaces). The lung tissue on the right of the image has relative preservation of the alveoli. The top of the image is very near the pleural surface. Courtesy Nephron
Emphysema_Lung_10x Micrograph of empysema lung showing dialated, large alveoli separated by thin septa. Some septae are ruptured and appear to be floating in the alveloar spaces. Grossly emphysematous lung appears pale and voluminous. Source DEPARTMENT OF PATHOLOGY, CALICUT MEDICAL COLLEGE
Gross Anatomy of Upper Lobe and Apical Centrilobular Emphysematous Changes and Normal Lung Below
Gross Anatomy of Upper Lobe and Apical Centrilobular Emphysematous Changes Ashley Davidoff MD
Normal Secondary Lobule
Secondary Lobule The top image (a) shows an anatomic drawing of a secondary lobule of the lung subtended by a lobular bronchiole (lb) and arteriole (pa). The interlobular septum contains the venule (red) lymphatic (yellow) and septum (maroon) The anatomical specimen of the lung (b) shows normal intralobular parenchyma while image c shows the centrilobular arteriole (navy blue) and centrilobular bronchiole (teal) and interlobular venule (red) and lymphatics (yellow) The interlobular septum is slightly thickened Ashley Davidoff TheCommonVein.net
Normal CT
Normal CT of the Upper Lung Fields on Lung Windows Ashley Davidoff TheCommonVein.net
Centrilobular Emphysema Gross Pathology
Emphysema This is an image of an emphysematous lung. Note the larger air spaces where the septae between the alveoli, alveolar sac alveolar ducts and respiratory bronchioles have been broken down (green). The bronchovascular bundle consisting of the arteriole (navy blue) and bronchiole (teal) subtends the secondary lobule. The pulmonary venule (red) originates from interlobular septa where it is intimately related to the lymphatics. 19932e
Apical Emphysematous Changes Ashley Davidoff MD 19.jpg
Electron Microscopy
SEM lung with emphysema David Gregory & Debbie Marshall Licence: Attribution 4.0 International (CC BY 4.0)
CXR Emphysema
Diaphragm in Emphysema Flattened and Partially Inverted Ashley Davidoff MD TheCommonvein.net
Emphysema-flatteneddiaphragms-iverted-by-tendons-64f-001.jpg
Diaphragm in Emphysema
Flattened and Partially Inverted
Ashley Davidoff MD TheCommonvein.net
The lateral examination of the chest shows the classical barrel shape to the chest with an increase in the retrosternal air space and flattening of the #signs in medicine Ashley Davidoff MD TheCommonVein.net
CT Scan of Centrilobular Emphysema Swiss Cheese
001-66f-centrilobular-emphysema-b.8.jpg
CT Scan of Centrilobular Emphysema
The axial CT of a 66 year old female with moderately severe centrilobular emphysema of the upper lobes. The magnified views show the focal central punctate density of the pulmonary artery indicating the presence of the central bronchovascular bundle (red arrow)
Ashley Davidoff MD The Common Vein.net
Side by Side Normal and Centrilobular Emphysema
Normal and Emphysema The imaging difference between healthy lungs (thumbs up) and emphysematous lungs (thumbs down) Ashley Davidoff MD TheCommonVeein.net lungs-0071 key words emphysema, CTscan cigarettes smoking
Pathophysiology of Cigarette Smoking on Medium Sized Airways, Small Airways and Alveoli
Pathophysiology of Cigarette Smoking on Medium Sized Airways, Small Airways and Alveoli Ashley Davidoff TheCommonVein.net lungs-00683
Structural Effects of Smoking on the Respiratory Bronchiole , Alveolar Ducts and Alveolar Sacs
Structural Effects of Smoking on the Membranous Airways (respiratory bronchiole, alveolar ducts, alveolar sacs) At the level of the membranous airways the effect is predominantly related to the loss of elasticity, vessel destruction and aberrant accumulation of smoking related macrophages. The weakening and destruction results in emphysema and the abnormal accumulation of smoking related macrophages relates to DIP Ashley Davidoff TheCommonVein.net lungs-00685
lungs-00687-lo-res.jpg
Smoking and the Alveolus –
The effect of the proteases and and elastases cause destruction of the alveoli and loss of elasticity, and therefore overall function. The destruction leads to bullous disease
The accumulation of smokers macrophage, and in the case of Langerhans cell histiocytosis leads to space occupation of the alveoli also reducing function
Ashley Davidoff TheCommonVein.net lungs-00687
It Starts at the Respiratory Bronchiole
Normal Acinus and Emphysema Image on the left shows normal size and appearance of terminal bronchioles and alveoli. On the right the image shows the effects on the respiratory bronchioles and when severe, on the alveoli as well Ashley Davidoff MD TheCommonVein.net
CT scan of Normal Lungs and Lungs with Centrilobular Emphysema Caused by Cigarette Smoking Ashley Davidoff Art TheCommonVein.net
Axial view of the upper lobes of a 66year female with centrilobular emphysema shows an expanded lobule with a centrilobular vessel in the middle characteristic of centrilobular emphysema Ashley Davidoff MD TheCommonvein.net
66f-centrilobular-emphysema-003.jpg
Magnified view of the upper lobes of a 66year female with centrilobular emphysema shows an expanded lobule with a centrilobular vessel in the middle characteristic of centrilobular emphysema
Ashley Davidoff MD TheCommonvein.net
Emphysema
Centrilobular emphysema is an
obstructive lung disease
caused by
obstructive bronchiolitis affecting the
region of the proximal respiratory bronchiole
allowing air into the secondary lobule but inhibiting
exhalation with resultant
air trapping and destruction of lung tissue
Destruction of small airways can lead to the formation of large bullae
EMPHYSEMA Micrograph showing emphysema (left ? large empty spaces) and lung tissue with relative preservation of the alveoli (right) Courtesy Nephron
MORGAGNI Giovanni Battista Morgagni, who made one of the earliest recorded descriptions of emphysema in 1769 Public Domain
References and Links