"The clinical features of emphysema should be distinguished from the signs and symptoms of chronic bronchitis. Patients with emphysema are hypocapnic and historically referred to as "pink puffers". This compares with the hypercapnia and cyanosis of chronic bronchitis, with patients referred to historically as "blue bloaters". In practice, features of these two syndromes coexist as chronic obstructive pulmonary disease."
"Except in the case of very advanced disease with bulla formation, chest radiography does not image emphysema directly, but rather implies the diagnosis due to associated features 2-3,9:"
"flattened hemidiaphragm(s): the most reliable sign"
"MRI "
"Emphysema is one of the entities grouped under the overarching term chronic obstructive pulmonary disease (COPD) and is best thought of primarily as a pathological rather than clinical entity. The Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease (GOLD) is explicit that patients present with COPD, rather than emphysema 11."
"Prognosis is worse in patients who continue to smoke, are alpha-1-antitrypsin deficient, have low FEV1 at time of diagnosis, or have other comorbidities (e.g. heart failure, respiratory failure, frequent exacerbations)."
"Centrilobular or centriacinar emphysema 12 is the most common type and affects the proximal respiratory bronchioles, particularly of the upper zones. It has a strong dose-dependent association with smoking 3. Rarely, severe centrilobular emphysema can be seen in the bases in patients with Salla disease 4."
"Centrilobular or centriacinar emphysema 12 is the most common type and affects the proximal respiratory bronchioles, particularly of the upper zones. It has a strong dose-dependent association with smoking 3. Rarely, severe centrilobular emphysema can be seen in the bases in patients with Salla disease 4."
"Panlobular or panacinar emphysema 12 affects the entire secondary pulmonary lobule and is more pronounced in the lower zones, matching areas of maximal blood flow. It is seen particularly in alpha-1-antitrypsin deficiency (exacerbated by smoking) 2-4, intravenous injection of methylphenidate (Ritalin lung) 3 or Swyer-James syndrome 4."
"Panlobular or panacinar emphysema 12 affects the entire secondary pulmonary lobule and is more pronounced in the lower zones, matching areas of maximal blood flow. It is seen particularly in alpha-1-antitrypsin deficiency (exacerbated by smoking) 2-4, intravenous injection of methylphenidate (Ritalin lung) 3 or Swyer-James syndrome 4."
"Panlobular or panacinar emphysema 12 affects the entire secondary pulmonary lobule and is more pronounced in the lower zones, matching areas of maximal blood flow. It is seen particularly in alpha-1-antitrypsin deficiency (exacerbated by smoking) 2-4, intravenous injection of methylphenidate (Ritalin lung) 3 or Swyer-James syndrome 4."
"Paraseptal or distal acinar emphysema 12 affects the peripheral parts of the secondary pulmonary lobule and is usually located adjacent to the pleural surfaces (including pleural fissures) 3. It is also associated with smoking and can lead to the formation of subpleural bullae and spontaneous pneumothorax 3."
"Paraseptal or distal acinar emphysema 12 affects the peripheral parts of the secondary pulmonary lobule and is usually located adjacent to the pleural surfaces (including pleural fissures) 3. It is also associated with smoking and can lead to the formation of subpleural bullae and spontaneous pneumothorax 3."
Expected headings
"Severity assessment"
"Centrilobular emphysema"
"Panlobular emphysema"
"Paraseptal emphysema"
"MRI "
"It should be remembered, however, that the most common plain film appearance of COPD is "normal" and the role of chest radiography is to eliminate other causes of lung symptoms such as infection, bronchiectasis or cancer 6."
"CT is the modality of choice for detecting emphysema; HRCT chest is particularly effective. It should be noted, however, that there is a relatively poor correlation between autopsy-proven emphysema, pulmonary function test abnormalities and CT, with 20% of pathology-proven cases not being evident on CT and 40% of patients with abnormal CT having normal pulmonary function tests."
"Prognosis is worse in patients who continue to smoke, are alpha-1-antitrypsin deficient, have low FEV1 at time of diagnosis, or have other comorbidities (e.g. heart failure, respiratory failure, frequent exacerbations)."