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Emphysema
Laura E. Heyneman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Advanced destructive emphysema (ADE)
              • Centrilobular emphysema (CLE)
              • Panlobular emphysema (PLE)
              • Lung volume reduction surgery (LVRS)
              • Usual interstitial pneumonia (UIP)
            • Synonyms

              • Panlobular = panacinar
              • Giant bullous emphysema = vanishing lung syndrome
            • Definitions

              • Emphysema: Destruction of alveolar walls and permanent dilation of airspaces distal to terminal bronchioles
              • Bulla: Focal lucency measuring > 1 cm in diameter with sharply demarcated thin wall
              • CLE: Destruction of alveolar walls and dilation of alveoli near centrilobular bronchioles
                • Sparing of peripheral alveoli close to interlobular septa
              • PLE: Destruction of all alveolar walls and dilation of all alveoli throughout secondary pulmonary lobule
              • Paraseptal emphysema: Destruction of alveolar walls and dilation of alveoli at periphery of secondary pulmonary lobules
                • Centrally located alveoli near centrilobular bronchiole are spared

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Kligerman S et al: Clinical-radiologic-pathologic correlation of smoking-related diffuse parenchymal lung disease. Radiol Clin North Am. 54(6):1047-1063, 2016
                                        2. Ostridge K et al: Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J. 48(1):216-28, 2016
                                        3. Shah PL et al: Lung volume reduction for emphysema. Lancet Respir Med. ePub, 2016
                                        4. Edwards RM et al: Imaging of small airways and emphysema. Clin Chest Med. 36(2):335-47, x, 2015
                                        5. Franks TJ et al: Smoking-related "interstitial" lung disease. Arch Pathol Lab Med. 139(8):974-7, 2015
                                        6. Lynch DA et al: CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. 277(1):192-205, 2015
                                        7. Walsh SL et al: Interstitial lung disease related to smoking: imaging considerations. Curr Opin Pulm Med. 21(4):407-16, 2015
                                        8. Lee SM et al: Thoracic magnetic resonance imaging for the evaluation of pulmonary emphysema. J Thorac Imaging. 28(3):160-70, 2013
                                        9. Lynch DA et al: Quantitative computed tomography in chronic obstructive pulmonary disease. J Thorac Imaging. 28(5):284-90, 2013
                                        10. Smith BM et al: Establishing normal reference values in quantitative computed tomography of emphysema. J Thorac Imaging. 28(5):280-3, 2013
                                        11. Sharma N et al: Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 24(3):227-30, 2009
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Advanced destructive emphysema (ADE)
                                                    • Centrilobular emphysema (CLE)
                                                    • Panlobular emphysema (PLE)
                                                    • Lung volume reduction surgery (LVRS)
                                                    • Usual interstitial pneumonia (UIP)
                                                  • Synonyms

                                                    • Panlobular = panacinar
                                                    • Giant bullous emphysema = vanishing lung syndrome
                                                  • Definitions

                                                    • Emphysema: Destruction of alveolar walls and permanent dilation of airspaces distal to terminal bronchioles
                                                    • Bulla: Focal lucency measuring > 1 cm in diameter with sharply demarcated thin wall
                                                    • CLE: Destruction of alveolar walls and dilation of alveoli near centrilobular bronchioles
                                                      • Sparing of peripheral alveoli close to interlobular septa
                                                    • PLE: Destruction of all alveolar walls and dilation of all alveoli throughout secondary pulmonary lobule
                                                    • Paraseptal emphysema: Destruction of alveolar walls and dilation of alveoli at periphery of secondary pulmonary lobules
                                                      • Centrally located alveoli near centrilobular bronchiole are spared

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Kligerman S et al: Clinical-radiologic-pathologic correlation of smoking-related diffuse parenchymal lung disease. Radiol Clin North Am. 54(6):1047-1063, 2016
                                                                              2. Ostridge K et al: Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J. 48(1):216-28, 2016
                                                                              3. Shah PL et al: Lung volume reduction for emphysema. Lancet Respir Med. ePub, 2016
                                                                              4. Edwards RM et al: Imaging of small airways and emphysema. Clin Chest Med. 36(2):335-47, x, 2015
                                                                              5. Franks TJ et al: Smoking-related "interstitial" lung disease. Arch Pathol Lab Med. 139(8):974-7, 2015
                                                                              6. Lynch DA et al: CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. 277(1):192-205, 2015
                                                                              7. Walsh SL et al: Interstitial lung disease related to smoking: imaging considerations. Curr Opin Pulm Med. 21(4):407-16, 2015
                                                                              8. Lee SM et al: Thoracic magnetic resonance imaging for the evaluation of pulmonary emphysema. J Thorac Imaging. 28(3):160-70, 2013
                                                                              9. Lynch DA et al: Quantitative computed tomography in chronic obstructive pulmonary disease. J Thorac Imaging. 28(5):284-90, 2013
                                                                              10. Smith BM et al: Establishing normal reference values in quantitative computed tomography of emphysema. J Thorac Imaging. 28(5):280-3, 2013
                                                                              11. Sharma N et al: Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review. J Thorac Imaging. 24(3):227-30, 2009