Emphysema

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Emphysema is a common medical lung disease strongly associated with smoking.

Emphysema
Diagnosis in short

Emphysematous changes. H&E stain.

LM alveoli too large, thin septa (no interstitial thickening)
Subtypes centriacinar (centrilobular) emphysema, panacinar (panlobular) emphysema, distal (paraseptal) acinar emphysema, irregular emphysema
Gross usually upper lobe predominant - blebs, bullae
Site lung

Associated Dx +/-pneumothorax
Syndromes Alpha-1 antitrypsin deficiency, others

Clinical history +/-smoking
Signs barrel chest
Symptoms shortness of breath
Prevalence common
Radiology hyperinflation
Prognosis dependent on underlying cause
Treatment stop smoking, bullectomy

Chronic obstructive pulmonary disease, abbreviated COPD, redirects here.

General

Causes of emphysema other than smoking:[3]

Pathologic classification

Based on morphology:[4]

  1. Centriacinar (centrilobular) emphysema - associated with heavy smoking.
  2. Panacinar (panlobular) emphysema - associated with alpha-1 antitrypsin deficiency.
  3. Distal (paraseptal) acinar emphysema - associated with spontaneous pneumothorax.
  4. Irregular emphysema - usu. insignificant.
  • Q. Why does smoking lead to centriacinar emphysema?
  • A. The bad stuff from smoking gets enters the acinus at the centre; ergo, this is the location of the most damage.

Gross

  • Holes (blebs, bullae), usually upper lung field predominant.
  • Lungs may overlap the heart.[5]

Notes:

Microscopic

Features:[5]

  • Large alveoli.
  • Thin septa (no interstitial thickening).

Images

See also

References

  1. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 368. ISBN 978-1416054542.
  2. Leslie, Kevin O.; Wick, Mark R. (2004). Practical Pulmonary Pathology: A Diagnostic Approach (1st ed.). Churchill Livingstone. pp. 296. ISBN 978-0443066313.
  3. Lee, P.; Gildea, TR.; Stoller, JK. (Dec 2002). "Emphysema in nonsmokers: alpha 1-antitrypsin deficiency and other causes.". Cleve Clin J Med 69 (12): 928-9, 933, 936 passim. PMID 12546267.
  4. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 368. ISBN 978-1416054542.
  5. 5.0 5.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 369. ISBN 978-1416054542.
  6. URL: http://dictionary.reference.com/browse/bleb. Accessed on: 3 August 2011.
  7. URL: http://dictionary.reference.com/browse/bulla. Accessed on: 3 August 2011.