5. Emphysema
Definition: Abnormal permanent
enlargement of the airspaces distal to the
terminal bronchiole, accompanied by
destruction of their walls and without
obvious fibrosis.
Spaces in parenchyma > 1mm = Abnormal
6. Emphysema
Emphysema causes dilation of air
spaces by destruction of alveolar wall,
leading to collapse of alveoli during
expiration
7.
8. Emphysema & Overinflation
• Emphysema: Increased air space with
destruction
• Overinflation: Increased air space without
destruction
9. Posteroanterior (PA) and lateral chest radiograph in a patient
with severe chronic obstructive pulmonary disease (COPD).
Hyperinflation, depressed diaphragms, increased retrosternal
space, and hypovascularity of lung parenchyma is demonstrated.
10. A lung with
emphysema shows
increased
anteroposterior (AP)
diameter, increased
retrosternal airspace,
and flattened
diaphragms on lateral
chest radiograph.
11. Severe bullous
disease
observed on
CT scan in a
patient with
COPD
15. A
RB Centrilobular
TB
Panlobular
Paraseptal
Irregular
16. Centriacinar :
[ centrilobular, Proximal acinar ]
• Dilatation of Respiratory Bronchiole
• Upper lobes - severely involved
• Can coexist with chronic bronchitis
• Invariably occurs in smokers
• Coal mine workers [carbon, dust]
17. CENTRIACINAR
FIGURE 15-7 A, Centriacinar emphysema. Central areas
show marked emphysematous damage (E), surrounded by
relatively spared alveolar spaces. B, Panacinar emphysema
involving the entire pulmonary lobule.
21. Paraseptal (Distal Acinar)
• Localized along pleura - peripheral part
of the acinus
• Predisposes to spontaneous peumothorax
• Adjacent to foci of fibrosis
• Least common
22. Mixed – IRREGULAR EMPHYSEMA:
• MOST COMMON
• LEAST SIGNIFICANT
• COMMON AROUND SCAR TISSUE
• COMBINATION OF TYPES
32. Pathophysiology
• Expiratory narrowing of bronchioles >
Air flow obstruction > underventilation
• Mismatch between ventilation & perfusion
• Can lead to chronic cor pulmonale
41. Fig-1 Bullous emphysema with large subpleural bullae (upper left)
Fig-2 Chronic obstructive pulmonary disease (COPD). Gross pathology of a patient with
44. Clinical picture
• Dysponea
• Cough with or without expectoration
• Wheezing
• Loss of weight
• Peptic ulceration
• Hypercapnia > changes in central
nervous system
• Barrel chest
47. Obstructive Pulmonary diseases
• Disorders Associated with Airflow
Obstruction
• Chronic bronchitis, Emphysema, Asthma,
Bronchiectasis & Bronchiolitis come under
this category
48. Venn diagram of chronic obstructive pulmonary disease (COPD).
Chronic obstructive lung disease is a disorder in which subsets of
patients may have dominant features of chronic bronchitis,
emphysema, or asthma. The result is irreversible airflow obstruction.
49. COPD
• COPD: Comprises Emphysema and chronic
bronchitis
• Many patients have overlapping features of
damage at both the acinar level (emphysema) and
bronchial level (bronchitis)
• Common extrinsic trigger— cigarette smoking —
is implicated in both the diseases
50. Figure 15-9 Schematic representation of evolution of
chronic bronchitis (left) and emphysema (right).
51. Natural history of COPD
• Pathological process (for years)
> clinical symptoms
• Survival is variable
• Respiratory failure > terminal phase of disease
• 2/3 dead < 2 years
• DEATH: - Respiratory acidosis and coma
- Chronic cor pulmonale
- Spontaneous pneumothorax