Copd Asthma Bronchiolitis

1. CHRONIC AIRFLOW OBSTRUCTION
Dr.Niranjan patil
Professor ; Radio diagnosis
D.Y patil medical college and hospital
Kolhapur.

2. ■ A group of diffuse lung diseases associated with chronic airflow obstruction includes:
 chronic obstructive pulmonary disease (COPD),
 asthma,
 and obliterative bronchiolitis.

3. Chronic obstructive pulmonary disease (copd)
■ The Global Initiative for Chronic Obstructive Pulmonary (Lung) Disease (GOLD) (56) defines COPD in functional
terms, as persistent, usually progressive airflow limitation established spirometrically, as a decrease in the FEV1/FVC
to less than 0.70, that cannot be reversed following bronchodilatortherapy.
■ Two main components of copd are :
 emphysema
 Chronic bronchitis

4. EMPHYSEMA
• Emphysema is a pathologic diagnosis that is defined as an abnormal, permanent enlargement of the airspaces distal to
the terminal bronchiole, accompanied by destruction of alveolar walls, and without obvious fibrosis.

5. Etiology and Pathogenesis.
■ There is also a causal relationship between HIV infection and
the development of early emphysema.
■ Various genetic disorders may be associated with emphysema
including α1-antitrypsin deficiency, heritable diseases of
connective tissue such as cutix laxa, Marfan syndrome and
familial emphysema.

6. CLASSIFICATION OF EMPHYSEMA
■ The pathologic classification of emphysema is based on the portion of the secondary pulmonary lobule affected:
■ CENTRILOBULAR
■ PANLOBULAR
■ PARASEPTAL
■ IRREGULAR

8. CENTRILOBULA
R EMPHYSEMA

9. PANACINAR
EMPHYSEM
A

10. PARASEPTAL
EMPHYSEM
A

11. IRREGULAR
EMPHYSEM
A

12. BULLOUS EMPHYSEMA
■ Syndrome of bullous emphysema, or giant bullous emphysema known as “vanishing lung syndrome” or “primary bullous
disease of the lung” –is the presence of large (occupy at least one third of a hemithorax), progressive upper lobe bullae, which
occupy a significant volume of a hemithorax and often asymmetric.

15. CHEST RADIOGRAPH
■ Hyperinflated lung,
 Low hemidiaphragm (at or below 7th anterior rib)Flat hemidiaphragm (<1.5 cm distance between line connecting the costo and
cardiophrenic angles and top of midhemidiaphragm)
 Retrosternal air space >2.5 cm
 “Barrel chest" -enlarged antero-posterior chest diameter
 Saber-sheath trachea
 Pulmonary vascular pruning and distortion(± pulmonary arterial hypertension)

25. DIFFERENTIAL DIAGNOSIS
■ Honeycombing
■ Pneumatoceles
■ Cystic lung disease
■ Bronchiolitis obliterans
■ Centrilobular

27. CHRONIC BRONCHITIS
■ It is defined as a productive cough occurring on most days for at least 3 consecutive months and for not less than 2
consecutive years.
■ Other causes of chronic productive cough, including bronchiectasis, tuberculosis, and other chronic infections, must
be excluded before the diagnosis of chronic bronchitis can be made.

28. ■ Causes:
■ cigarette
■ smoking,
■ air pollution and
■ infection.

29. ■ Bronchial submucosal hyperplasia, smooth muscle hypertrophy, chronic inflammation and the obstruction of small
airways.
■ Airflow obstruction, which is concentrated in the small bronchioles has reversible (mucous plugging, inflammation,
smooth muscle hypertrophy) and irreversible components (fibrosis and stenosis).

30. Radiographic Features
■ CXR:
■ -No abnormality in 21–30% of patients,
■ -Overinflation and oligaemia,
■ -”Tram line "appearance –are parallel lines spaced approx. 3mm apart.
■ -Bronchial wall thickening
■ -Accentuation of linear lung markings.
■ -‘Dirty chest’
■ -Sabre-sheath trachea

32. Dirty chest seen in chronic bronchitis

35. ASTHMA
■ Asthma is a chronic inflammatory condition involving the airways that causes bronchial hyper-
responsiveness and induces recurrent episodes of wheezing, breathlessness, chest tightness and coughing,
usually associated with widespread but variable airflow obstruction that is often reversible either
spontaneously or after bronchodilator inhalation.

39. Radiographic Features
■ ACUTE SIGNS:
■ CXR:
■ -overinflation and air trapping: flattened diaphragmatic dome
■ -Deepened retrosternal air space
■ -Peribronchial cuffing (inflammation of airway wall)
■ -Bronchial dilatation
■ -Localised areas of hypoattenuation
■
■ CHRONIC CHANGES:
■ CXR:
■ -Normal in 73%,
■ -Central ring shadows - bronchiectasis
■ -Scars (from recurrent infections)

40. ■ CT in asthma has been restricted to the identification of associated conditions, such as ABPA and
detection of condition that may mimic asthma, such as hypersensitivity pneumonitis, obliterative
bronchiolitis, Churg-Strauss syndrome or chronic eosinophilic pneumonia

44. OBLITERATIVE (CONSTRICTIVE) BRONCHIOLITIS
■ Obliterative bronchiolitis is a condition characterized by bronchiolar and peribronchiolar inflammation and fibrosis that
ultimately leads to luminal obliteration affecting membranous and respiratory bronchiolitis

46. ■ The chest radiograph is often normal. In a small number of patients, mild hyperinflation, subtle peripheral
attenuation of the vascular makings, widespread and conspicuous abnormalities in lung attenuation, and
central bronchiectasis may be seen.

47. ■ HRCT (expiration-inspiration images):
■ “Mosaic perfusion" of lobular air trapping (85-100%)
■ Bronchial wall thickening (87%)
■ Bronchiectasis (66-80%)
■ Patchy air trapping on expiratory scans
■ Poorly defined nodular areas of consolidation
■ “Tree-in-bud" appearance
■ Centrilobular ground-glass opacities.

50. ■ DDx:
■ (1)Bacterial or fungal pneumonia (response to antibiotics, positive cultures)
■ (2)Chronic eosinophilic pneumonia (young female, eosinophilia)
■ (3)Usual interstitial pneumonia (irregular opacities, decreased lung volume)

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