Emphysema

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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, Saber-sheath trachea (associated with COPD)
Prognosis dependent on underlying cause
Treatment stop smoking, bullectomy

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

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.

Note:

  • Why does smoking lead to centriacinar emphysema?
    • 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:

Images

  • Centrilobular emphysema. (WC/Edwin Ewing Jr.)

Radiology

  • Saber-sheath trachea - a finding associated with COPD.[8]
    • Trachea's anterior to posterior dimension:left to right dimension is >2:1.[9]
  • Barrel-shaped chest.[10]

Microscopic

Features:[5]

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

Images

  • Emphysema. (WC)

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.
  8. ↑ Tunsupon P, Dhillon SS, Harris K, Alraiyes AH (February 2016). "Saber-sheath trachea in a patient with severe COPD". BMJ Case Rep 2016. doi:10.1136/bcr-2016-214648. PMC 4769447. PMID 26912770. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769447/.
  9. ↑ Webb EM, Elicker BM, Webb WR (May 2000). "Using CT to diagnose nonneoplastic tracheal abnormalities: appearance of the tracheal wall". AJR Am J Roentgenol 174 (5): 1315–21. doi:10.2214/ajr.174.5.1741315. PMID 10789785.
  10. ↑ "Physical signs in patients with chronic obstructive pulmonary disease". Lung India 36 (1): 38–47. 2019. doi:10.4103/lungindia.lungindia_145_18. PMC 6330798. PMID 30604704. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330798/.
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