000 Emphysema Centrilobular

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

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
- smoking
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.

Alveolar Wall Destruction Localized around a Bronchovascular Bundle.

Gross Anatomy of Upper Lobe and Apical Centrilobular Emphysematous Changes and Normal Lung Below

Normal Secondary Lobule

Normal CT

Centrilobular Emphysema Gross Pathology

Electron Microscopy

CXR Emphysema

CT Scan of Centrilobular Emphysema Swiss Cheese

Side by Side Normal and Centrilobular Emphysema

Pathophysiology of Cigarette Smoking on Medium Sized Airways, Small Airways and Alveoli

Structural Effects of Smoking on the Respiratory Bronchiole , Alveolar Ducts and Alveolar Sacs

It Starts at the Respiratory Bronchiole

Emphysema